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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

It has been estimated that about 320,000 to 400,000 patients in the USA alone are possible candidates to cardiac resynchronization therapy according to the recently published AHA/ACC/NASPE guidelines for pacing and the results of the COMPANION trial. The selection of the most suitable candidate for CRT/CRTD is a crucial issue, but still a matter of debate. A large variety of clinical, invasive and non-invasive criteria have been proposed for appropriately selecting candidates for CRT. However, in all the studies the parameters have been retrospectively identified and none has reported their results in the form of a multivariate regression model. We have now well characterized the patients in sinus rhythm who most likely benefit from this non-pharmacological approach. The fact that the COMPANION trial was able to single out a specific subgroup of heart failure patients that can be treated better than what was very short time ago best medical therapy validates the large body of research that investigators worldwide have created about this therapy. Finally, the concept that any patients that require ventricular pacing, who have heart failure class II/III or IV may benefit from receiving biventricular rather than right ventricular pacing as much as the other patients with more classical indication for CRT is still open to discussion and needs to be tested in a randomized multicenter trial.
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PMID:The promise of resynchronization therapy. Who (and how many) will benefit? 1276 11

Cardiac resynchronization therapy provides a new adjunct in the armamentarium of therapies available to patients who remain symptomatic despite optimized standard therapies. It does not cure heart failure; patients must maintain evidence-based therapies promoted by the American Heart Association and American College of Cardiology. Therapy benefits can be influenced by lead placement and device programming, so it is essential that qualified personnel are consulted to initiate and monitor therapy. While we await final analysis of COMPANION and other studies that definitively answer the question of mortality benefits, substantial data support CRT in reversing left ventricular remodeling, providing hemodynamic benefits, and most importantly, imparting clinical benefits related to functional status, symptoms, quality of life, and morbidity. Acute and critical care nurses can take an active role in promoting this intervention for patients with wide QRS and cardiac dyssynchrony who are likely to benefit through improvement in cardiac function and efficiency.
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PMID:Cardiac resynchronization therapy through biventricular pacing in patients with heart failure and ventricular dyssynchrony. 1283 Jun 91

CRT offers today another option for some patients with heart failure, side by side with more "traditional" therapies like drugs, assist devices, and heart transplantation. Clinical studies show that in properly selected patients a significant improvement in hemodynamic parameters and clinical status can be achieved by BV pacing. It is still unknown whether this type of therapy will also result in a survival benefit for patients with severe heart failure. The next few years certainly promise to be as exciting for CRT as were the last few.
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PMID:Cardiac resynchronization therapy: a new frontier in the management of heart failure. 1292

Landmark trials have demonstrated that biventricular pacing (also called cardiac resynchronisation therapy or CRT) in chronic heart failure due to left ventricular dysfunction improves symptomatic status, exercise capacity and quality of life. Yet critically, all-cause mortality has not been demonstrated to be reduced in any of the four randomised controlled trials with mortality data (CONTAK-CD, InSync implantable-cardioverter defibrillator (ICD), MIRACLE and MUSTIC). With the much larger COMPANION study now terminated, however, the currently available pooled data from all five trials shows a significant reduction in all-cause mortality, odds ratio (OR), 0.74: 95% confidence interval (CI) 0.56-0.97. This may now establish biventricular pacing as a standard therapy for a specific subset of patients with chronic heart failure and LBBB.
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PMID:Cardiac resynchronisation may reduce all-cause mortality: meta-analysis of preliminary COMPANION data with CONTAK-CD, InSync ICD, MIRACLE and MUSTIC. 1608 Sep 92

Cardiac resynchronization therapy is indicated in advanced heart failure refractory to optimal drug treatment patients with left ventricular systolic dysfunction and QRS >120 milliseconds. The choice of the device has to consider several parameters: Do we have to implant a CRT pacemaker or a intracardiac cardioverter defibrillator (ICD)? The prevalence of sudden cardiac death is high in heart failure patients. In patients with an ischemic cardiomyopathy, primary prevention of sudden cardiac death trials suggests to implant a biventricular ICD. In patients with a non ischemic cardiomyopathy, the question is more controversial althought the resullts of the SCD-HeFT and COMPANION trials yielded interesting results for iCD implantation. However, the final decision has to consider the patient's baseline characteristics such as age, presence of comorbidities and cost of the device. Today, devices with totally independent ports of the right and left ventricles have technical advantages and thus are more relevant. Cardiac resynchronization therapy is a heart failure treatment and the new devices provide new tools to assess heart failure parameters such as patient's activity, respiratory parameters or heart rate variability. Left ventricular pacing alone is currently under evaluation such as atrial fibrillation prevention algorithms, atrial fibrillation being frequent in herta failure patients with hemodynamic deleterious consequences.
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PMID:[Cardiac resynchronisation therapy: what kind of equipment to use?]. 1570 5

Several studies on the acute effect of cardiac resynchronization in patients with advanced heart failure (HF) and left bundle branch block (LBBB) have shown that left and biventricular stimulation increase pulse pressure and contractility, while patients with a QRS complex <150 ms may deteriorate during stimulation. Patients with LBBB, severe HF and a QRS width >150 ms underwent right, left and biventricular stimulation at different AV delays. Acute response was defined as > or =10% pulse pressure increase. 165 of 188 patients (88%) in sinus rhythm (47 women, mean age 62.5+/-10 years, ejection fraction 23+/-8%, NYHA class 3.1+/-0.3) were regarded acute responders. 10% of 103 patients with dilated cardiomyopathy and 16.5% of 79 patients with coronary artery disease were considered non-responders. 29 patients (81%) with 2 posterolateral veins were acute responders with 10 of them (33%) being responders in only one vein. 54 patients had a higher pulse pressure increase (10.7+/-10.6%) with atrio-left ventricular stimulation, 48 patients with atrio-biventricular stimulation (9.8+/-6.4%). At one-year follow-up, heart failure had significantly (p<0.0001) improved from NYHA class 3.1+/-0.4 to 2.1+/-0.7, VO(2)peak from 12.7+/-2.8 to 15.9+/-3.6 ml/min/kg. Left ventricular enddiastolic diameter being an indicator of reverse remodeling decreased from 80.5+/-10.5 to 73.3+/-13 (p<0.0001). Hemodynamic testing before CRT allows for the identification of acute non-responders as well as the best mode and site of stimulation and the optimal atrioventricular delay in responders.
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PMID:[Acute hemodynamic effects]. 1582 70

Cardiac resynchronisation therapy has become firmly established as a treatment for patients with symptomatic heart failure. Several randomised controlled trials and numerous observational studies have demonstrated improvements in exercise capacity and quality of life. Despite these advances it is clear that approximately 25% of patients who meet current criteria for implantation of such a device do not show objective evidence of clinical benefit. Implantation of a CRT device is expensive, time consuming and involves some risk so it is important to accurately identify patients who are likely to respond and to optimise pacing lead placement and device programming to maximise the benefit in these selected patients.
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PMID:Optimisation of cardiac resynchronisation therapy: addressing the problem of "non-responders". 1602 May 82

In conclusion, sudden cardiac arrest is a major cause of mortality in patients with LV dysfunction, even in asymptomatic patients. Low EF and heart failure may contribute synergistically to this risk, and may confer a risk of sudden death that accumulates over time. Several studies confirm that ICDs are more effective than optimal medical therapy at reducing SCA, although efforts must focus on optimizing medical therapy. Finally, ventricular dyssynchrony is a major risk factor for cardiac mortality that is best ameliorated by CRT. Future studies using markers of mechanical dyssynchrony will likely enhance the ability of CRT to reduce symptoms, hospitalization, and mortality.
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PMID:Implantable defibrillators with and without resynchronization for patients with left ventricular dysfunction. 1639 18

Despite the alleviation of symptoms and longer survival conferred by pharmacological management of chronic congestive heart failure (CHF), this progressive syndrome remains associated with high morbidity and premature death. A new treatment of CHF should ideally alleviate symptoms, improve functional capacity, decrease mortality, and slow or reverse its progression without adding risks for the patient that outweighs the benefits. Growing evidence indicates that devices implanted to resynchronize ventricular contraction are a beneficial adjunct in the treatment of CHF. This review discusses the remodelling process, and its clinical and prognostic significance. We also discuss the impact of CRT, on remodelling and disease progression with a particular focus on patients with asymptomatic or mild heart failure (NYHA Class I-II).
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PMID:Effects of cardiac resynchronization therapy on disease progression in chronic heart failure. 1644 8

Improved cardiac resynchronization by pacemakers (CRT-P) and implantable defibrillators (CRT-D) benefits cardiac function, reduces heart failure (HF) admissions, and diminishes mortality in patients with severe left ventricular (LV) dysfunction. In terms of mortality benefit, current evidence suggests that CRT-D may be better than CRT-P alone when a broad range of HF patients is considered. However, the differential benefit may be small in certain patients. In individuals with severe and worsening HF due to systolic LV dysfunction, HF complications other than ventricular tachyarrhythmias contribute importantly to both quality-of-life (QoL) and duration of survival; these patients may be served cost-effectively by CRT-P enhancing QoL. A clinical trial evaluating CRT-D vs. CRT-P in terms of QoL and survival in such patients would assist physicians and payers to understand better the relative roles of CRT-P and CRT-D in the care of the sickest HF patients.
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PMID:Cardiac resynchronization pacing without defibrillator capability: is this a viable option? 1679 63


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