Cardiac resynchronisation therapy in 2015: keeping up with the pace
A Voskoboinik1,2, A D McGavigan3, J A Mariani2,4
1Department of Cardiology, Western Hospital, Melbourne, Victoria, Australia.
Insights
Cardiac resynchronisation therapy (CRT) improves heart failure outcomes by refining patient selection and utilizing advanced imaging. New lead technologies promise further advancements in treating this widespread condition.
Area of Science:
- Cardiology
- Biomedical Engineering
Background:
- Heart failure (HF) remains a significant global health challenge, increasing morbidity and mortality.
- Cardiac resynchronisation therapy (CRT), or biventricular pacing, is a key treatment for HF.
- Evolving understanding of HF pathophysiology necessitates updated treatment strategies.
Purpose of the Study:
- To review recent advancements in CRT for heart failure management.
- To discuss changes in patient selection criteria for CRT.
- To explore emerging technologies and imaging modalities in CRT.
Main Methods:
- Analysis of current literature and guideline updates on CRT.
- Review of data on CRT in specific patient populations (e.g., atrial fibrillation, pacemaker-dependent).
- Examination of the role of multimodality imaging in CRT patient selection and lead placement.
Main Results:
- Updated guidelines emphasize improved patient selection to reduce CRT non-response rates.
- CRT efficacy in atrial fibrillation and pacemaker-dependent patients is increasingly understood.
- Multimodality imaging plays a crucial role in optimizing CRT outcomes.
Conclusions:
- Refined patient selection and advanced imaging are critical for maximizing CRT benefits.
- Emerging lead technologies hold promise for enhancing CRT effectiveness.
- Continued research and technological innovation are vital for addressing the growing heart failure epidemic.
Abstract:
Despite improved understanding of the pathophysiology of heart failure (HF) and availability of better medical therapies, HF continues to grow as a cause of morbidity and mortality in Australia and worldwide. Over the past decade, cardiac resynchronisation therapy (CRT), or biventricular pacing, has been embraced as a powerful weapon against this growing epidemic. However, much has changed in our understanding of dyssynchrony in HF, and this has led to a change in guidelines to ensure more appropriate selection of CRT candidates to improve the 'non-response' rate. More data have also emerged about the use of CRT in atrial fibrillation and in pacemaker-dependent patients. There has also been a growing focus on multimodality imaging to guide patient selection and lead positioning. Exciting new lead technologies are also emerging, with the potential to improve CRT outcomes further.
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