Related Experiment Video

Updated: Aug 9, 2026

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

Urgent cardiac resynchronization therapy in patients with decompensated chronic heart failure receiving inotropic

Yuval Konstantino1, Zaza Iakobishvili, Orna Arad

  • 1Department of Cardiology, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Petah-Tikva, Israel.

Cardiology
|April 14, 2006
PubMed

Insights

Cardiac resynchronization therapy (CRT) may improve symptoms in severe heart failure (HF) patients on inotropic drugs. However, this study found a high 50% mortality rate, indicating significant risks alongside potential benefits.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Severe decompensated Class IV heart failure (HF) patients on intravenous inotropic therapy represent a high-risk group.
  • The benefit of cardiac resynchronization therapy (CRT) in this specific patient population remains largely unknown.
  • Understanding CRT's role in advanced HF is crucial for optimizing treatment strategies.

Purpose of the Study:

  • To investigate the feasibility and clinical outcomes of urgent cardiac resynchronization therapy (CRT) implantation.
  • To assess the impact of CRT on symptomatic improvement in patients with severe decompensated Class IV heart failure requiring inotropic support.
  • To evaluate the short-term mortality associated with CRT in this challenging patient cohort.

Main Methods:

  • Retrospective identification of patients who underwent urgent CRT implantation for decompensated Class IV HF.
  • Inclusion criteria specified the necessity of intravenous inotropic therapy prior to or during CRT implantation.
  • Analysis of symptomatic response and mortality rates during follow-up.

Main Results:

  • Eight out of ten patients (80%) with chronic ischemic cardiomyopathy and prolonged QRS duration (median 170 ms) experienced symptomatic improvement after CRT.
  • Despite clinical improvement, the study observed a significant 50% mortality rate within a median follow-up of 9.5 months.
  • The median time from CRT implantation to death was 6 months, highlighting the critical condition of these patients.

Conclusions:

  • Cardiac resynchronization therapy (CRT) is technically feasible in patients with severe decompensated Class IV heart failure receiving intravenous inotropic treatment.
  • While CRT can lead to clinical improvement in a majority of these patients, the associated mortality risk remains substantial.
  • Further research is warranted to refine patient selection and management strategies for CRT in this high-risk HF population.
Abstract

More Related Videos

Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System10:17

Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System

Published on: April 11, 2025

Implantation of Total Artificial Heart in Congenital Heart Disease07:27

Implantation of Total Artificial Heart in Congenital Heart Disease

Published on: July 18, 2014

Related Concept Videos

Heart Failure Drugs: Inotropic Agents01:26

Heart Failure Drugs: Inotropic Agents

Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

Additional therapies for treating patients with heart failure (HF) may include procedural interventions, supplemental oxygen, the management of sleep disorders, and nutritional therapy.Procedural InterventionsImplantable Cardioverter-Defibrillator: For patients at risk of life-threatening arrhythmias due to severe left ventricular dysfunction, an Implantable Cardioverter-Defibrillator (ICD) can detect and terminate these arrhythmias, preventing sudden cardiac death and improving survival rates.
Cardiomyopathy II: Dilated Cardiomyopathy01:30

Cardiomyopathy II: Dilated Cardiomyopathy

Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
Heart Failure I: Introduction01:27

Heart Failure I: Introduction

Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...