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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
Criteria for patient selection in cardiac resynchronization therapy
Oliver Turschner1, Guido Ritscher, Helge Simon
1Department of Cardiology, Klinikum Coburg, Germany, Medizinische Klinik II, Klinikum Coburg, Ketschendorfer Str. 33, 96450 Coburg, Germany.
Insights
Cardiac resynchronization therapy (CRT) improves heart failure outcomes, but patient selection is key. This review summarizes CRT patient selection methods to optimize treatment success and reduce therapy costs.
Area of Science:
- Cardiology
- Medical Devices
Background:
- Cardiac resynchronization therapy (CRT) has improved prognosis in severe heart failure patients by reducing morbidity and mortality.
- However, a significant portion of patients do not benefit from CRT, or even experience deterioration.
Purpose of the Study:
- To provide an overview of CRT and summarize patient selection parameters.
- To highlight limitations in current CRT patient selection methods.
- To aid clinical decision-making for CRT by reviewing guidelines and potential new indications.
Main Methods:
- Review of multicenter trials and existing publications on CRT patient selection.
- Analysis of various methods for predicting positive or negative CRT response.
- Focus on current guidelines for CRT indication and device programming.
Main Results:
- Despite CRT's benefits, suboptimal patient selection and device programming contribute to treatment failure.
- Numerous predictive methods exist, but often yield contradictory results, necessitating clear guidelines.
- Current guidelines and selection parameters require refinement to optimize CRT outcomes.
Conclusions:
- Improved patient selection is crucial for enhancing the effectiveness of cardiac resynchronization therapy.
- A comprehensive understanding of selection parameters and adherence to guidelines can improve CRT success rates.
- Further research into new indications and refined selection criteria is warranted.
Abstract:
Since the implementation of cardiac resynchronization therapy (CRT) the prognosis of patients with severe heart failure has been improved owing to a reduction in morbidity and mortality rates, as several multicenter trials have shown. However, several patients treated by CRT still lack improvement or even deteriorate during therapy. In some of them, this might be due to the severity and progression of chronic heart failure. In others, the criteria for the indication of CRT and/or optimized device programming might have not been met. Thus, one important option to improve CRT outcome is to improve CRT patient selection. A lot of publications describing various methods identifying a positive or negative prediction of CRT have been released. In summary, decision making based on all these partly contradictory publications indicate a strong need for guidelines for the use of such expensive therapy. The purpose of this article is to give an overview of CRT and summarize the different methods and the limitations of CRT patient selection parameters. With the focus of the different guidelines, this article tries to give an appropriate overview and aid decision making in CRT patients, including a short view of possible new indications.
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