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Related Concept Videos

Heart Failure VI: Adjunct Therapies01:22

Heart Failure VI: Adjunct Therapies

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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.
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Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

929
Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
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Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

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Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
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Heart Failure I: Introduction01:27

Heart Failure I: Introduction

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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...
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Heart Failure Drugs: Diuretics01:22

Heart Failure Drugs: Diuretics

971
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
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Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

319
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...
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Related Experiment Video

Updated: Feb 4, 2026

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

David D Daly1, Michael R Gold1

  • 1Medical University of South Carolina, Charleston, South Carolina, US.

European Cardiology
|October 13, 2018
PubMed
Summary

Cardiac resynchronisation therapy (CRT) benefits selected heart failure patients with conduction delays. Recent advances expand CRT use and optimize lead placement, while routine AV delay optimization is no longer advised.

Keywords:
Cardiac resynchronisation therapyheart failurepacing

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Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Cardiac resynchronisation therapy (CRT) is established for symptomatic systolic heart failure with interventricular conduction delay.
  • Patient selection has evolved, expanding indications to include mild heart failure and specific cases requiring frequent right ventricular pacing.
  • CRT effectiveness in atrial fibrillation is linked to near-complete pacing, often necessitating atrioventricular (AV) junction ablation.

Purpose of the Study:

  • To review recent advancements and current best practices in cardiac resynchronisation therapy.
  • To highlight strategies for optimizing CRT outcomes and patient selection.
  • To clarify the role of AV delay optimization in CRT.

Main Methods:

  • Review of large clinical trials and recent advances in CRT.
  • Analysis of patient subgroups benefiting from CRT, including those with mild heart failure and atrial fibrillation.
  • Evaluation of lead placement strategies and AV delay optimization techniques.

Main Results:

  • CRT is beneficial for patients with left ventricular systolic dysfunction and conduction delays.
  • Expanded indications for CRT now include patients with mild heart failure and mildly reduced ejection fraction requiring right ventricular pacing.
  • Optimizing left ventricular (LV) lead placement is crucial for maximizing CRT response.
  • Routine AV delay optimization is not recommended based on multicenter trial results.

Conclusions:

  • CRT remains a vital therapy for specific heart failure populations.
  • Ongoing research focuses on refining patient selection and lead placement for improved CRT efficacy.
  • Current evidence suggests against routine AV delay optimization in CRT management.