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Why We Have to Use Cardiac Resynchronization Therapy-Pacemaker More.

Jean-Claude Daubert1, Raphaël Martins1, Christophe Leclercq1

  • 1University of Rennes, Rennes 35000, France.

Heart Failure Clinics
|November 26, 2016
PubMed
Summary

Cardiac resynchronization therapy with a pacemaker (CRT-P) is acceptable for heart failure. Upgrading to a biventricular implantable cardioverter-defibrillator (CRT-D) requires strong evidence, and downgrading CRT-D to CRT-P may be considered.

Keywords:
Cardiac resynchronization therapyChronic heart failurePacemaker

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Area of Science:

  • Cardiology
  • Medical Devices

Background:

  • Cardiac resynchronization therapy (CRT) using a pacemaker (CRT-P) or a biventricular implantable cardioverter-defibrillator (CRT-D) is established for chronic heart failure.
  • The clinical indications and cost-effectiveness of CRT-D versus CRT-P require careful consideration.

Purpose of the Study:

  • To evaluate the current evidence supporting the universal prescription of CRT-D for heart failure patients.
  • To discuss the appropriate selection criteria for CRT-P and CRT-D devices.
  • To explore potential strategies for device management, such as downgrading from CRT-D to CRT-P.

Main Methods:

  • Review of existing scientific literature on CRT-P and CRT-D efficacy and patient selection.
  • Analysis of clinical guidelines and expert consensus regarding device implantation.
  • Consideration of device longevity and patient outcomes.

Main Results:

  • Limited scientific evidence supports the routine use of CRT-D in all eligible heart failure patients.
  • CRT-P remains an acceptable therapeutic option.
  • Downgrading from CRT-D to CRT-P at battery depletion is a potential strategy for selected patients with significant reverse remodeling and no history of ventricular arrhythmias.

Conclusions:

  • The choice between CRT-P and CRT-D should be individualized based on clinical evidence and patient factors, not solely on device type.
  • Cost and complexity of CRT-D warrant judicious prescription.
  • Further research into device downgrading strategies could optimize patient management and resource utilization.