Cardiac resynchronization therapy: a breakthrough in heart failure management

Ståhlberg, Marcus; Lund, Lars H.; Zabarovskaja, Stanislava; Gadler, Fredrik; Braunschweig, Frieder; Linde, Cecilia

doi:10.1111/j.1365-2796.2012.02580.x

Cited by 11 publications

(2 citation statements)

References 109 publications

(163 reference statements)

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“…Electrical dyssynchrony is evidenced by QRS prolongation (≥120 ms) and has a prevalence of 15-30% in HF population. Electrical dyssynchrony, and the subsequent abnormal mechanical activation, results in cellular, structural, hemodynamic, and ultimately clinical adverse effects [45]. Left bundle branch block results in a shorter diastolic time interval and longer isovolumetric contraction and relaxation times, which impair pump function because of abnormal electrical and mechanical properties, as well as functional MR.…”

Section: Electrical Resynchronizational Support (Ers)mentioning

confidence: 99%

Invasive Treatment in Advanced (Stage-D) Heart Failure

Kırali¹,

Yerlikhan²,

Hançer³

2017

Cardiomyopathies - Types and Treatments

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Heart failure is a complex, true pandemic clinical syndrome and is responsible for 5% of hospitalizations globally. Severe heart failure can manifest as two lethal clinical entities: (1) acute cardiac decompensation with cardiogenic shock after large acute myocardial infarction with mortality rates approaching 50% or after cardiac surgery with mortality rates higher than 65% and (2) chronic destructive cardiac remodeling or acute decompensative exacerbations of cardiomyopathies with one-year mortality of approximately 80% (worse than most types of cancer). Interventional therapies aim first to improve symptoms and life expectancy in patients with severe heart failure syndrome, second to prevent left ventricular remodeling, and third to bridge patients to long-term mechanical circulatory support or transplantation. Several treatment options can be used to stabilize patients. In particular, new percutaneous mitral valve interventions and short-term circulatory support devices open up a new temporary treatment area in symptomatic Stage-D heart failure. The durable or curable surgical destination treatment will be only permanent ventricular assist devices or heart transplantation. This chapter focuses on the treatment steps and new approaches in hospitalized Stage-D heart failure patients.Keywords: heart failure, heart transplantation, ventricular assist device, ECMO, ECLS At end-stage, any type of cardiomyopathy (CMP) causes a complex clinical heart failure (HF) syndrome, which results from structural and/or functional impairment of ventricular filling or ejection. This dire clinical situation can cause an adverse vicious cycle that is ultimately fatal if not treated by pharmacological or invasive mechanical support or heart transplantation (HTx). Left ventricular functional abnormalities range from normal-sized left ventricle (LV) with preserved left ventricular ejection fraction (LVEF) to severe left ventricular dilatation (LVD) with markedly reduced LVEF. Reduced LVEF is defined as the clinical diagnosis of HF and LVEF ≤40%, which means a clinic and functional association of systolic and/or diastolic LVD.© 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Abnormal systolic and/or diastolic functions impair left ventricular contractile and relaxation functions that result in increasing left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV), as well as left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD), with the alteration of the left ventricular shape from conical form to spherical form. Adverse elevation of preload and afterload results in increasing left ventricular end-diastolic pressure (LVEDP) and left ventricular end-systolic pressure (LVESP). Inadequate unloading is the pr...

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Section: Electrical Resynchronizational Support (Ers)mentioning

confidence: 99%

Invasive Treatment in Advanced (Stage-D) Heart Failure

Kırali¹,

Yerlikhan²,

Hançer³

2017

Cardiomyopathies - Types and Treatments

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“…5,24 Information on the outcomes of pediatric CRT is limited to case reports and several retrospective single-center and multicenter studies with heterogeneous CHD populations (Table I in the online-only Data Supplement and Tables 1 and 2).…”

Section: Outcomes Of Permanent Crt In Pediatric and Chdmentioning

confidence: 99%

Cardiac Resynchronization Therapy for Pediatric Patients With Heart Failure and Congenital Heart Disease

Motonaga

Dubin

2014

Circulation

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1879C ardiac resynchronization therapy (CRT) is an effective treatment for adult patients with left ventricular (LV) failure. Large prospective, randomized, controlled trials have demonstrated that CRT results in improvement in cardiac function, LV reverse remodeling, decreased hospitalizations for heart failure (HF), improved quality of life, and decreased overall mortality.1-5 However, 30% of adult patients are nonresponders to CRT, spurring further evaluation of electromechanical dyssynchrony to determine optimal pacing sites and to improve CRT selection criteria for maximal response. 1,6 The positive response in adult HF prompted exploration of the use of CRT in pediatric HF patients. However, the effectiveness of CRT in the pediatric population is difficult to evaluate because of the complex anatomic substrates of congenital heart disease (CHD) and scar formation from multiple cardiac surgeries with a higher proportion of right bundle-branch block (RBBB) and right ventricular (RV) failure than in the adult population. The typical adult HF scenario of an LV ejection fraction (EF) ≤35% with a left bundle-branch block (LBBB) is uncommon in children; therefore, the adult selection criteria for CRT cannot be easily translated to pediatric patients. Furthermore, a small heterogeneous pediatric patient population hinders a systematic assessment of long-term benefit from CRT. Principles of CRTIn the normal heart, ventricular electrical activation spreads through the His-Purkinje system, which has unique rapid propagation properties and widespread distribution. This allows highly coordinated electrical activation between distant regions of both ventricles, resulting in highly synchronous mechanical contraction. Given the strong relationship between electrical excitation and mechanical contraction in the myocardium, it is not surprising that abnormal electrical activation results in abnormal mechanical contraction. 7,8 During a spontaneous or pacing-induced bundle-branch block, ventricular activation spreads primarily cell to cell through the surrounding myocardium, which can be up to 4 times slower than the specialized His-Purkinje system. 9,10 This results in asynchronous electrical activation and thus asynchronous mechanical contraction in which opposing regions of the ventricular wall become out of phase with each other. Energy generated by contraction of early activated regions is dissipated by relaxation of late-activated regions, leading to decreased energy efficiency, depressed pump function, and deleterious ventricular remodeling. 11-14Approximately 25% of adults with HF exhibit a LBBB with mechanical dyssynchrony. CRT has traditionally targeted this electrical and mechanical dyssynchrony with biventricular pacing.15 By simultaneously pacing both ventricles, CRT uniformly prolongs the time to maximum contraction in each ventricle as the activation wave fronts from both ventricles merge. 16,17 This results in a more coordinated contraction pattern, more homogeneous distribution of regional loading conditions ...

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Electrophysiology Interventions

Salgado

Ghaye

2013

Cardiac CT

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Cardiac resynchronization therapy: a breakthrough in heart failure management

Cited by 11 publications

References 109 publications

Invasive Treatment in Advanced (Stage-D) Heart Failure

Invasive Treatment in Advanced (Stage-D) Heart Failure

Cardiac Resynchronization Therapy for Pediatric Patients With Heart Failure and Congenital Heart Disease

Electrophysiology Interventions

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