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Individualized cardiac resynchronization therapy: current status

Authors Ruwald M, Bruun N

Received 13 August 2014

Accepted for publication 12 September 2014

Published 7 November 2014 Volume 2014:5 Pages 305—317

DOI https://doi.org/10.2147/RRCC.S50541

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Richard Kones


Martin H Ruwald,1,2 Niels E Bruun1,3

1Department of Cardiology, Gentofte Hospital, Hellerup, Denmark; 2Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, NY, USA; 3Clinical Institute, Aalborg University, Aalborg, Denmark

Abstract: Cardiac resynchronization therapy (CRT) has shown a substantial reduction in heart failure patient morbidity and mortality, with improvement in quality of life as well as symptoms. The therapy is, however, limited to approximately 10%–15% of heart failure patients and, typically, 30% do not derive benefit from the device. For optimal outcomes with CRT, the correct selection of patients is of paramount importance. The first parameter is depressed left ventricular systolic function, and the second is a wide QRS complex. Different nuances among clinical trials have rendered guidelines pragmatic and compromising, but also conflicting and confusing. A large proportion of real-life CRTs are implanted in patients where the evidence for benefit is scarce or not present. Further, for optimal benefit, patients require evidence-directed medical therapy at maximal doses, effective placement of ventricular leads, and high biventricular pacing percentages, along with optimized atrioventricular (AV) and interventricular interval device programming. These items, as well as specific clinical characteristics, such as AV block and atrial fibrillation, in the context of CRT indications, are discussed. This review focuses on these issues to guide the clinician through guidelines, with an evidence-based update on the current status of CRT.

Keywords: Cardiac resynchronization therapy, prognosis, review, biventricular pacing, guideline, indications
 

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