Skip Navigation

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Charles, R.G
Right arrow Search for Related Content
PubMed
Right arrow Articles by Charles, R.G
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?


Cardiac resynchronization therapy: when and for whom?

R.G Charles*

Cardiothoracic Centre, Liverpool, U.K.

* Correspondence: Richard G. Charles, Cardiothoracic Centre, Thomas Drive, Liverpool, L14 3PE, U.K.

Abstract

Potential candidates for cardiac resynchronization therapy (CRT) include patients with symptomatic congestive heart failure despite optimal medical therapy, who also have evidence of ventricular dyssynchrony, particularly left bundle branch block, with QRS duration in excess of 150 ms. Dyssynchrony may additionally be identified by echo-Doppler examination and tagged magnetic resonance imaging. Improved exercise capacity and quality of life, reduced sympathetic activation and fewer ventricular tachyarrhythmias are potential benefits of CRT. Ongoing trial results will be required to refine patient selection criteria and to demonstrate the possibility for prognostic as well as symptomatic benefit.

Key Words: Biventricular • cardiac pacemaker • congestive heart failure • resynchronization

References

  1. Nishimura RA, Hayes DL, Holmes DR Jr, Tajik AJ. Mechanism of hemodynamic improvement by dual chamber pacing for severe left ventricular dysfunction: an acute Doppler and catheterization hemodynamic study. J Am Coll Cardiol. 1995;25:281–288[Abstract]
  2. Hochleitner M, Hortnagl H, Fridrich L, Gschnitzer F. Long-term efficacy of physiologic dual-chamber pacing in the treatment of end- stage idiopathic dilated cardiomyopathy. Am J Cardiol. 1992;70:1320–1325[CrossRef][Web of Science][Medline]
  3. Auricchio A, Sommariva L, Salo RW, Scafuri A, Chiariello L. Improvement of cardiac function in patients with severe congestive heart failure and coronary artery disease by dual chamber pacing with shortened AV delay. Pacing Clin Electrophysiol. 1993;16:2034–2043[CrossRef][Medline]
  4. Linde C, Gadler F, Edner M, Nordlander R, Rosenqvist M, Ryden L. Results of atrioventricular synchronous pacing with optimized delay in patients with severe congestive heart failure. Am J Cardiol. 1995;75:919–923[CrossRef][Web of Science][Medline]
  5. Brecker SJD, Xiao HB, Sparrow J, Gibson DG. Effects of dual chamber pacing with short atrioventricular delay in dilated cardiomyopathy. Lancet. 1992;340:1308–1312[CrossRef][Web of Science][Medline]
  6. ACC/AHA Guidelines for Implantation of Cardiac Pacemakers and Arrhythmia Devices. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Pacemaker Implantation). J Am Coll Cardiol. 1998;31:1175–1209[Free Full Text]
  7. Stevenson WG, Stevenson LV, Middlekauff HR, et al. Improving survival for patients with advanced heart failure: a study of 737 consecutive patients. J Am Coll Cardiol. 1995;26:1417–1423[Abstract]
  8. Gottipaty VK, Krelis P, Lu F, et al, For the VEST Investigators. The resting echocardiogram provides a sensitive and inexpensive marker of prognosis in patients with chronic congestive heart failure. [abstract]J Am Coll Cardiol. 1999;33:145A
  9. Kass DA, Chen C-H, Curry C, et al. Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation. 1999;99:1567–1573[Abstract/Free Full Text]
  10. Bakker PF, Meijburg HW, de Vries J, et al. Biventricular pacing in end-stage heart failure improves functional capacity and left ventricular function. J Interv Card Electrophysiol. 2000;4:395–404[CrossRef][Web of Science][Medline]
  11. Nelson G, Berger R, Fetics B, et al. Left ventricular or biventricular pacing improves cardiac function at diminished cost in patients with dilated cardiomyopathy and left bundle branch block. Circulation. 2000;102:3053–3059[Abstract/Free Full Text]
  12. Breithardt OA, Stellbrink C, Diem B, et al, On behalf of the PATH CHF Investigators. Effect of chronic multisite pacing on left ventricular volumes in patients with congestive heart failure. [abstract]Pacing Clin Electrophysiol. 1999;22:732
  13. Xiao HB, Brecker SJ, Gibson DG. Differing effects of right ventricular pacing and left bundle branch block on left ventricular function. Br Heart J. 1993;69:166–173[Abstract/Free Full Text]
  14. Reuter S, Garrigue S, Labeque J-N, et al. Biventricular pacing improves end stage heart failure patients with complete right bundle branch block: potential mechanisms and haemodynamic data over a one year follow-up. [abstract]Pacing Clin Electrophysiol. 2001;24:620
  15. Sassara M, Achilli A, Fucili S, et al. Efficacy of cardiac resynchronisation in narrow QRS patients. [abstract]Europace. 2001;2(suppl B):465
  16. Nelson GS, Curry CW, Wyman BT, et al. Predictors of systolic augmentation from left ventricular pre-excitation in patients with dilated cardiomyopathy and intraventricular conduction delay. Circulation. 2000;101:2703–2709[Abstract/Free Full Text]
  17. Reuter S, Garrigue S, Bordachar P, et al. Long-term clinical and haemodynamic assessment of biventricular pacing for heart failure: characterization of non-responders. [abstract]Pacing Clin Electrophysiol. 2001;24:539[Medline]
  18. Stellbrink C, Auricchio A, Diem B, et al. Potential benefit of biventricular pacing in patients with congestive heart failure and ventricular tachyarrythmia. Am J Cardiol. 1999;83:143D–150D[Web of Science][Medline]
  19. Farwell D, Patel NR, Hall A, Ralph S, Sulke AN. How many people with heart failure are appropriate for biventricular resynchronisation? Eur Heart J. 2000;21:1246–1250[Abstract/Free Full Text]
  20. Daoud E, Hummel J, Higgins S, et al. Does ventricular resynchronisation therapy influence total survival? [abstract]Pacing Clin Electrophysiol. 2001;24:539
  21. Hamdan M, Zagrodzky J, Joglar J, et al. Biventricular pacing decreases sympathetic activity compared with right ventricular pacing in patients with depressed ejection fraction. Circulation. 2000;102:1027–1032[Abstract/Free Full Text]
  22. Saxon LA, Boehmer JP, Hummell J, et al. Biventricular pacing in patients with congestive heart failure: two prospective randomized trials. The Vigor CHF and Ventak CHF Investigators. Am J Cardiol. 1999;83:120D–123D[Web of Science][Medline]
  23. Higgins S, Young P, Scheck D, et al. Biventricular pacing diminished the need for implantable cardioverter defibrillator therapy. J Am Coll Cardiol. 2000;36:824–827[Abstract/Free Full Text]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Charles, R.G
Right arrow Search for Related Content
PubMed
Right arrow Articles by Charles, R.G
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?