Cardiac resynchronization therapy in congestive heart failure: Ready for prime time?

摘要: Abstract Objectives/background The aim of this article is to critically review the data accumulated date on application cardiac resynchronization therapy (CRT) via biventricular pacing techniques manage patients with advanced heart failure. from studies evaluating effects long-term right ventricular (RV) are also briefly reviewed. Methods MEDLINE and selective journal searches English-language reports a search references relevant papers were conducted. Results Cardiac dyssynchrony as reflected by prolonged QRS complex, often in form left bundle branch block, encountered about 30% moderate-to-advanced Among these patients, 10% 15% candidates for CRT pacing. Accumulated evidence randomized controlled over last few years has indicated significant hemodynamic clinical improvement conferred class III or IV failure idiopathic ischemic dilated cardiomyopathy having low ejection fraction (≤35%) wide complex (≥120–150 ms). Newer suggest reduction overall mortality hospitalization, particularly when combined automatic defibrillator backup. Technical advances percutaneous methods accessing tributaries veins have raised success rate implantation leads >90%. Further confirmation ongoing trials awaited, more cost-effectiveness needed before considered prime time population. If confirm survival benefit CRT, use electrical at earlier stages might be contemplated. New recent suggests deleterious effect long-standing practice producing an iatrogenic block conventional RV apical receiving permanent pacemakers. Thus, already become poignantly aware harmful spontaneous emerging new would dictate change attitude direct our attention alternate sites pacing, such ventricle and/or outflow tract, if not all then least those dysfunction. Conclusions offers failure, it significantly prolong selected devices defibrillation backup used. confirmatory needed, issues cost efficacy must resolved vital therapeutic alternative ready patients.