cardiac resynchronization therapy
Jump to navigation
Jump to search
Introduction
biventricular pacing device with ICD
Indications
- heart failure*, NYHA class III or IV
- used with implantable cardioverter-defibrillator[8]
- cardiac dyssynchrony[4][5][17]
- LVEF <= 35%[4]
- QRS duration > 120 msec[4][17]; >= 150 msec[13]
- sinus rhythm
- ambulatory NYHA class IV HF despite optimal medical therapy[4][13]
- may be of benefit in patients with moderate heart failure[9]
- left atrial volume < 40 mL/m2
- left ventricular end-diastolic volume > 125 mL/m2
- non-ischemic cause of cardiomyopathy
- QRS duration > 150 msec[14]
- left bundle-branch block (LBBB)*[14] or intraventricular conduction delay[23]
- female
- prior hospitalization for heart failure
* diminishes all-cause mortality & improves the quality of life
* diminished mortality benefit of CRT limited to patients with LBBB or intraventricular conduction delay[18][23]
* His bundle pacing may be non-inferior to CRT[22]
Contraindications
- not helpful for patients with narrow QRS complex[6][15]
- not useful for right bundle branch block[23]
Procedure
- an ICD with placement of an additional lead in the coronary sinus[17]
Complications
- loss of left ventricular capture can worsen heart failure[3]
- device-related infection: 1.9 vs 1.0% for ICD alone (RR=1.90)[17]
- device related complications 2% (same as ICD alone)[17]
Notes
- may be less cost-effective than other forms of therapy
- implantable cardioverter-defibrillators (ICDs) & cardiac resynchronization therapy (CRT) devices often include a feature that measures intrathoracic impedance, potentially providing an early warning system for decompensation by detecting pulmonary fluid retention[10]
- mortality: 25.7 vs 29.8% for ICD alone (RR=0.82)[17]
- hospital readmissions: 68.6 vs 72.8% for ICD alone (RR=0.86)
- use labeled inappropriate in 27% of cases[21]
More general terms
Additional terms
References
- ↑ Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM; Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004 May 20;350(21):2140-50. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15152059
- ↑ Journal Watch 24(20):154, 2004
McAlister FA, Ezekowitz JA, Wiebe N, Rowe B, Spooner C, Crumley E, Hartling L, Klassen T, Abraham W. Systematic review: cardiac resynchronization in patients with symptomatic heart failure. Ann Intern Med. 2004 Sep 7;141(5):381-90. Epub 2004 Aug 16. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15353430
Nichol G, Kaul P, Huszti E, Bridges JF. Cost-effectiveness of cardiac resynchronization therapy in patients with symptomatic heart failure. Ann Intern Med. 2004 Sep 7;141(5):343-51. Epub 2004 Aug 16. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15353425 - ↑ 3.0 3.1 Journal Watch 25(16):127, 2005 Ammann P, Sticherling C, Kalusche D, Eckstein J, Bernheim A, Schaer B, Osswald S. An electrocardiogram-based algorithm to detect loss of left ventricular capture during cardiac resynchronization therapy. Ann Intern Med. 2005 Jun 21;142(12 Pt 1):968-73. Summary for patients in: Ann Intern Med. 2005 Jun 21;142(12 Pt 1):I24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15968011
- ↑ 4.0 4.1 4.2 4.3 4.4 Hunt SA et al American College of Cardiology Foundation, American Heart Association. 2009 focused update incorporated into the ACC/AHA 2005 guidelines for the diagnosis and management of heart failure in adults [trunc]. J Am Coll Cardiol 2009 Apr 14;53(15):e1-e90. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19358937
Hunt SA et al Developed in Collaboration With the American College of Chest Physicians and the International Society for Heart and Lung Transplantation; Endorsed by the Heart Rhythm Society. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult-Summary Article A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2005 Sep 20;46(6):1116-43. (No abstract) PMID: https://www.ncbi.nlm.nih.gov/pubmed/161683044 - ↑ 5.0 5.1 Bleeker GB, Holman ER, Steendijk P, Boersma E, van der Wall EE, Schalij MJ, Bax JJ. Cardiac resynchronization therapy in patients with a narrow QRS complex. J Am Coll Cardiol. 2006 Dec 5;48(11):2243-50. Epub 2006 Nov 9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17161254
Yu CM, Chan YS, Zhang Q, Yip GW, Chan CK, Kum LC, Wu L, Lee AP, Lam YY, Fung JW. Benefits of cardiac resynchronization therapy for heart failure patients with narrow QRS complexes and coexisting systolic asynchrony by echocardiography. J Am Coll Cardiol. 2006 Dec 5;48(11):2251-7. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17161255 - ↑ 6.0 6.1 Beshai JF et al, for the RethinQ Study Investigators Cardiac-resynchronization therapy in heart failure with narrow QRS complexes. N Engl J Med 2007, Nov 4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17986493
- ↑ Jessup M et al 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009 Apr 14;119(14):1977-2016. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19324967
- ↑ 8.0 8.1 8.2 Tang ASL et al for the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT) Investigators. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med 2010 Nov 14; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21073365 <Internet> http://dx.doi.org/10.1056/NEJMoa1009540
Moss AJ. Preventing heart failure and improving survival. N Engl J Med 2010 Nov 14; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21073362 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1011742 - ↑ 9.0 9.1 Al-Majed NS et al Meta-analysis: Cardiac Resynchronization Therapy for Patients With Less Symptomatic Heart Failure Annals of Internal Medicine Feb 14, 2011 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21320922 <Internet> http://www.annals.org/content/early/2011/02/11/0003-4819-154-6-201103150-00313.full
Reynold CR and Jessup M Translating the Benefits of Cardiac Resynchronization Therapy Widely and Wisely: Challenges Remain Annals of Internal Medicine Feb 14, 2011 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21320924 <Internet> http://www.annals.org/content/early/2011/02/11/0003-4819-154-6-201103150-00314.full - ↑ 10.0 10.1 Journal Watch Massachusetts Medical Society Journal Watch Cardiology November 30, 2011 http://cardiology.jwatch.org
- ↑ 11.0 11.1 Goldenberg I et al. Predictors of response to cardiac resynchronization therapy in the Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy (MADIT-CRT). Circulation 2011 Oct 4; 124:1527. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21900084
- ↑ 12.0 12.1 Hsu JC et al. Predictors of super-response to cardiac resynchronization therapy and associated improvement in clinical outcome: The MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy) study. J Am Coll Cardiol 2012 Jun 19/26; 59:2366 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22698490
Ellenbogen KA and Huizar JF. Foreseeing super-response to cardiac resynchronization therapy: A perspective for clinicians. J Am Coll Cardiol 2012 Jun 19/26; 59:2374 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22698491 - ↑ 13.0 13.1 13.2 Medical Knowledge Self Assessment Program (MKSAP) 16, 17, 18. American College of Physicians, Philadelphia 2012, 2015, 2018.
- ↑ 14.0 14.1 14.2 Peterson PN et al QRS Duration, Bundle-Branch Block Morphology, and Outcomes Among Older Patients With Heart Failure Receiving Cardiac Resynchronization Therapy. JAMA. 2013;310(6):617-626 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23942680 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1728715
- ↑ 15.0 15.1 Ruschitzka F et al. for the EchoCRT Study Group. Cardiac-resynchronization therapy in heart failure with a narrow QRS complex. N Engl J Med 2013 Sep 1 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23998714
Yancy CW and McMurray JJV. ECG - Still the best for selecting patients for CRT. N Engl J Med 2013 Sep 1 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23998715 - ↑ Goldenberg I et al. Survival with cardiac-resynchronization therapy in mild heart failure. N Engl J Med 2014 Mar 30 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24678999
- ↑ 17.0 17.1 17.2 17.3 17.4 17.5 17.6 Gore JM Cardiac Resynchronization Therapy in the Real World NEJM Journal Watch. Jun 4, 2014 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
Masoudi FA et al. Comparative effectiveness of cardiac resynchronization therapy with an implantable cardioverter-defibrillator versus defibrillator therapy alone: A cohort study. Ann Intern Med 2014 May 6; 160:603 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24798523 - ↑ 18.0 18.1 18.2 18.3 Zusterzeel R et al. Cardiac resynchronization therapy in women: US Food and Drug Administration meta-analysis of patient-level data. JAMA Intern Med 2014 Jun 23 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25090172 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1881932
- ↑ Epstein AE, DiMarco JP, Ellenbogen KA et al 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2013 Jan 22;61(3):e6-75 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23265327
- ↑ Russo AM, Stainback RF, Bailey SR et al ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 appropriate use criteria for implantable cardioverter-defibrillators and cardiac resynchronization therapy: a report of the American College of Cardiology Foundation appropriate use criteria task force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol. 2013 Mar 26;61(12):1318-68 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23453819
- ↑ 21.0 21.1 Sandhu A, Bao H, Minges KE et al. Use of cardiac resynchronization therapy defibrillator in US hospitals. JAMA Cardiol 2019 Jun 19; PMID: https://www.ncbi.nlm.nih.gov/pubmed/31215970
- ↑ 22.0 22.1 Vinther M et al. A randomized trial of His pacing versus biventricular pacing in symptomatic heart failure patients with left bundle branch block (His-Alternative). JACC Clin Electrophysiol 2021 Apr 25; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/34167929 https://www.sciencedirect.com/science/article/abs/pii/S2405500X21003285
- ↑ 23.0 23.1 23.2 23.3 Friedman DJ et al. Cardiac resynchronization therapy improves outcomes in patients with intraventricular conduction delay but not right bundle branch block: A patient-level meta-analysis of randomized controlled trials. Circulation 2023 Mar 7; 147:812 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36700426 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.122.062124