Abstract
Patients with advanced heart failure have a high mortality and morbidity despite medical therapy. Depending on the underlying heart disease and severity of heart failure, 3.7 to 52.8% of patients have a QRS complex ≥120 ms who may have interventricular and intraventricular dyssynchrony correctible by cardiac resynchronization therapy (CRT). The latter is usually achieved with biventiricular pacing, with the left ventricular lead placed in a tributary of the coronary sinus (CS), with a reported success rate between 88–92%. The technical advances for implantation include preformed guide sheaths to canulate the CS, over the wire leads with passive fixation mechanism, and surgical placement methods.
Device-specific CRT features include optimizing heart failure through ensurance of a high percentage of pacing, heart failure monitoring, atrioventricular and interventricular timing, and avoiding double ventricular sensing. Furthermore, arrhythmic co-morbidities of heart failure such as atrial fibrillation and ventricular tachyarrhythmias can also be managed. Recent prospective trials suggest that there is a 30% reduction in heart failure hospitalization with CRT, and preliminary results suggest a survival benefit with CRT and implantable cardioverter defibrillator over optimal medical therapy.
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Lau, CP., Barold, S., Tse, HF. et al. Advances in Devices for Cardiac Resynchronization in Heart Failure. J Interv Card Electrophysiol 9, 167–181 (2003). https://doi.org/10.1023/A:1026365006526
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DOI: https://doi.org/10.1023/A:1026365006526