Heart failure affects a high percentage of the population, especially older patients. Cardiac resynchronization therapy is indicated in some patients with advanced heart failure. However, 20-40% of patients with implanted resynchronization device have no clinical response. In this chapter, we review factors related with the absence of a clinical response, recent technological advances that can reduce the failure rate, and an algorithm for management of patients without a clinical response.
Background: Hyperthermia is frequent after cardiac arrest, and is associated with poor vital and neurological prognosis. In the last few years there have been published some studies that show benefits with moderate hypothermia in these patients, and other studies haven´t shown such benefits. Aim: To collect all clinical trials evaluating the utility of moderate therapeutic hypothermia in survivors of a cardiac arrest. Method: A comprehensive search of clinical trials evaluating moderate hypothermia in patients who survive a cardiac arrest was carried out. The mortality and quality of life of the survivors were evaluated. The quality of the included studies, the publication bias and the heterogeneity of the results were evaluated. Results: there is no significant reduction in mortality (RR 0.97, 95% CI 0.93-1.01) or increase in quality of life (RR 1.07, 95% CI 0.94-1.21) of the patients undergoing moderate hypothermia versus those not treated with that. There are no different results in patients with cardiac arrest with defibrillable and non -defibrillable rhythms, with the different used cooling methods, or even with the induction of intra -cardiac arrest hypothermia. The mortality of these patients is high, and there are no significant differences in relation to the age or sex of them. Conclusion: In patients who survive a cardiac arrest, the induction of moderate hypothermia is not recommended.
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