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[Refractory heart failure. Multisite stimulation].

Alessandro Boccanelli1, Fiorenzo Gaita

  • 1Dipartimento per le Malattie dell'Apparato Cardiocircolatorio Azienda Ospedaliera San Giovanni-Addolorata Via dell'Amba Aradam, 8 00184 Roma. boccanelli.a@tin.it

Italian Heart Journal. Supplement : Official Journal of the Italian Federation of Cardiology
|November 1, 2002
PubMed
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Cardiac resynchronization therapy (CRT) improves heart function in patients with dilated cardiomyopathy and intraventricular conduction delay. CRT shows benefits regardless of QRS duration, suggesting activation sequence is key.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Context:

  • Intraventricular conduction delay, like left bundle branch block, affects one-third of dilated cardiomyopathy patients.
  • Conduction delays cause unsynchronized contractions, impairing ventricular function and prognosis.
  • Abnormal heart rhythms and contractile dyssynchrony are common in heart failure.

Purpose:

  • To review the pathophysiological basis and therapeutic effects of cardiac resynchronization therapy (CRT).
  • To evaluate CRT's impact on left ventricular function, remodeling, and patient outcomes.
  • To discuss current inclusion criteria and future research directions for CRT.

Summary:

  • CRT, using biventricular pacing, corrects intraventricular conduction delays and restores physiological atrioventricular timing.

Related Experiment Videos

  • Studies demonstrate CRT's short- and long-term benefits, including improved left ventricular function, quality of life, and reduced rehospitalization.
  • Positive outcomes are observed even in patients with QRS duration < 150 ms and atrial fibrillation, highlighting the importance of activation sequence.

    • Impact:

    • CRT offers significant improvements in surrogate endpoints for heart failure patients with specific criteria.
    • Ongoing studies aim to determine if CRT prolongs survival in heart failure patients.
    • Current guidelines recommend CRT for carefully selected patients with moderate to severe heart failure.