Pacing for heart failure: selection of patients, techniques and benefits

Auricchio, Angelo; Klein, Helmut U.; Spinelli, Julio

doi:10.1016/s1388-9842(99)00037-9

Cited by 23 publications

(4 citation statements)

References 28 publications

(34 reference statements)

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“…It is likely that many new interventions for heart failure will be targeted at specific groups of patients rather than the whole population. Cardiac dyssynchrony, a complex multi‐component syndrome, has recently been identified as one such target [2–4]. Atrio‐ventricular, regional left ventricular and inter‐ventricular dyssynchrony can all lead to a decline in global cardiac performance.…”

Section: Introductionmentioning

confidence: 99%

The CARE‐HF study (CArdiac REsynchronisation in Heart Failure study): rationale, design and end‐points

Cleland

Daubert

Erdmann

et al. 2001

European J of Heart Fail

284

151

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Background: Cardiac resynchronisation is a promising new intervention for patients with heart failure, left ventricular systolic dysfunction and ventricular dyssynchrony. Objecti¨e: The CARE-HF trial is designed to evaluate the long-term effects Ž . of cardiac atrio-bi-ventricular resynchronisation on the mortality and morbidity of patients with heart failure due to left ventricular systolic dysfunction already receiving diuretics and optimal medical therapy with ACE inhibitors and beta-blockers Ž . where indicated and tolerated . Methods and Results: Approximately 800 patients will be randomised to device therapy or control and followed for a minimum of 18 months. A pragmatic study design has been chosen that does not attempt to conceal allocation from investigators or patients because it is impossible to guarantee maintenance of blinding for the duration of the study. The end-points committee will adjudicate events in a blinded fashion. Since cardiac resynchronisation may alter other aspects of the management of the patient, as would occur in clinical practice, the study should be considered a comparison of strategies rather than simply of a device. The primary end-point is all-cause mortality or unplanned cardiovascular hospitalisation. The study should complete recruitment during

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Section: Introductionmentioning

confidence: 99%

The CARE‐HF study (CArdiac REsynchronisation in Heart Failure study): rationale, design and end‐points

Cleland

Daubert

Erdmann

et al. 2001

European J of Heart Fail

284

151

View full text Add to dashboard Cite

show abstract

“…CRT is a unique intervention for heart failure as it is the only treatment, so far, that increases blood pressure (BP) and improves outcome [1]. A rise in BP is often one of the immediate responses to CRT and is used by some to pick the site for LV pacing [53]. Interestingly, low SBP is one of the few variables that independently predict a greater response to CRT (Fig.…”

Section: Blood Pressurementioning

confidence: 99%

Cardiac resynchronization therapy: dyssynchrony imaging from a heart failure perspective

Cleland

Cullington²,

Khaleva³

et al. 2008

Current Opinion in Cardiology

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“…7,16 These short-term hemodynamic investigations of CRT led to long-term observational (uncontrolled) trials of CRT that showed consistent, sustained improvements in exercise tolerance, quality of life, NYHA functional class, and cardiac performance. [17][18][19][20][21][22][23][24][25] Of course, the definitive proof supporting a role for CRT in heart failure management awaited the completion of subsequent largescale, randomized, single-and double-blind, controlled clinical trials.…”

Section: Response By Greenberg and Mehra P 2698 The Rationale For Crtmentioning

confidence: 99%

All Patients With Heart Failure and Intraventricular Conduction Defect or Dyssynchrony Should Not Receive Cardiac Resynchronization Therapy

Greenberg

Mehra

2006

Circulation

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C ase Presentation: J.S., a 72-year-old man, was diagnosed with heart failure 5 years ago. Before that, he had suffered a large anterior myocardial infarction and had undergone successful coronary artery bypass grafting surgery. An internal cardioverter-defibrillator (ICD) was implanted 3 years ago. He was hospitalized briefly for decompensated heart failure 9 months ago, and his medical regimen was intensified at that time. He subsequently resumed his usual activities, which included daily walks of up to several hundred yards around his company's construction work site and 2 to 3 rounds of golf weekly. His only symptoms were fatigue after 36 holes of golf and shortness of breath while walking uphill rapidly. Medications included 0.125 mg digoxin, 40 mg furosemide, and target doses of an angiotensin-converting enzyme inhibitor, a ␤-blocker, and warfarin. An ECG demonstrated atrial fibrillation with a controlled ventricular response. The QRS duration was 130 ms with a left bundle-branch block pattern. On echocardiogram, the left ventricular (LV) ejection fraction (EF) was 23% with anterior wall akinesis; the LV internal diastolic dimension was 83 mm; and there was trace mitral regurgitation. Cardiac resynchronization therapy (CRT) was recommended. Placement of an LV pacing lead and "upgrading" his ICD to an ICD/biventricular pacemaker was performed uneventfully. Response by Abraham p 2691Shortly after the procedure, he experienced recurrent ventricular tachyarrhythmias, and his ICD, which had not discharged since implantation, delivered 4 shocks over a 24-hour period to terminate episodes of ventricular fibrillation. There was no evidence of acute myocardial infarction, worsening heart failure, or a pericardial effusion. The ventricular arrhythmias were responsive to intravenous amiodarone. After 7 days, he was discharged on oral amiodarone in addition to his other medications. Over the next several weeks, he had only 1 episode of ventricular tachycardia terminated by pacing. During this period, however, he complained of fatigue, malaise, and gastrointestinal symptoms. Amiodarone was discontinued, and over the next several weeks, these symptoms resolved. There were no further ventricular arrhythmias, and J.S. resumed his activities at work and on the

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Pacing for heart failure: selection of patients, techniques and benefits

Cited by 23 publications

References 28 publications

The CARE‐HF study (CArdiac REsynchronisation in Heart Failure study): rationale, design and end‐points

The CARE‐HF study (CArdiac REsynchronisation in Heart Failure study): rationale, design and end‐points

Cardiac resynchronization therapy: dyssynchrony imaging from a heart failure perspective

All Patients With Heart Failure and Intraventricular Conduction Defect or Dyssynchrony Should Not Receive Cardiac Resynchronization Therapy

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