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Chapter-72 Cardiac Resynchronization Therapy

BOOK TITLE: Textbook of Cardiology (A Clinical & Historical Perspective)

Author
1. Rao BH Sripathi
ISBN
9789350900819
DOI
10.5005/jp/books/12259_72
Edition
1/e
Publishing Year
2013
Pages
9
Author Affiliations
1. Yenepoya Dental College and Hospital, Mangalore, Nair Hospital Dental College, Mumbai, Maharashtra, India
Chapter keywords
Cardiac resynchronization therapy (CRT), congestive heart failure (CHF), angiotensin-converting enzyme (ACE) inhibitors, symptomatic heart failure patients, sinus rhythm, nonspecific intraventricular conduction defects

Abstract

Cardiac resynchronization therapy (CRT) has proven to be a definitive therapy for some patients with congestive heart failure (CHF) where symptoms persist despite optimal medical therapy including diuretics, angiotensin-converting enzyme (ACE) inhibitors, beta blockers and digoxin. Clinical data gathered in the last decade has decisively placed this therapy in the algorithm of heart failure management with an established role in alleviation of symptoms, reduction in hospitalizations and mortality. Resynchronization of both atria and ventricles was achieved by a regular dual chamber pacemaker resulting in clinical improvement in the patient. Cardiac resynchronization therapy has been shown to be effective in symptomatic heart failure patients in sinus rhythm with systolic left ventricular (LV) dysfunction having wide QRS. More refined and sensitive markers of LV dyssynchrony need to be investigated to extend therapy to patients with minimal or no QRS prolongation, and to those with right bundle branch block (RBBB) and nonspecific intraventricular conduction defects. Larger trials are needed to assess the impact of multi site LV pacing. Innovations in integrative technologies are likely to make electronic programming and optimization of pacing parameters less time consuming and easier.

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