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Ongoing trials of cardiac resynchronisation.

J G F Cleland1, J Ghosh, N Khan

  • 1Department of Cardiology, Castle Hill Hospital and Hull Royal Infirmary, University of Hull, Kingston upon Hull, UK. J.G.Cleland@medschool.hull.ac.uk

Minerva Cardioangiologica
|June 5, 2003
PubMed
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Cardiac resynchronisation therapy (CRT) shows promise for heart failure patients unresponsive to medication. Ongoing trials investigate its impact on survival, but it remains an experimental treatment requiring careful patient selection and informed consent.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Heart failure is a growing concern with high mortality despite pharmacological treatments.
  • Existing therapies offer only partial symptom relief and do not significantly improve prognosis.
  • Device-based therapies present a promising avenue for improving heart failure outcomes.

Purpose of the Study:

  • To evaluate the efficacy of cardiac resynchronisation therapy (CRT) in heart failure patients.
  • To assess CRT's impact on morbidity and mortality in specific patient subgroups.
  • To explore potential new indications for CRT in various heart failure etiologies.

Main Methods:

  • Two large clinical trials (CARE-HF and COMPANION) are evaluating CRT in patients with heart failure, systolic dysfunction, and ventricular dyssynchrony.

Related Experiment Videos

  • Studies are also examining CRT in patients with atrial fibrillation and diastolic heart failure.
  • The MADIT-II study assessed defibrillator implantation in heart failure patients with reduced ejection fraction.

    • Main Results:

    • CRT has demonstrated symptom improvement in heart failure patients refractory to optimal medical therapy.
    • Defibrillators show a small benefit in heart failure patients with severely depressed ejection fraction.
    • Greater benefit from defibrillators is observed in patients with ECG markers of cardiac dyssynchrony (QRS >150 msec).

    Conclusions:

    • CRT is a promising therapy for select heart failure patients, particularly those with ventricular dyssynchrony.
    • Ongoing trials are crucial for establishing definitive evidence on CRT's effects on morbidity and mortality.
    • Patients should be informed that CRT is still considered experimental and requires careful consideration of risks and benefits.