scholarly journals Cardiac resynchronization therapy in patients with chronic heart failure: the view of a therapist, cardiologist

2019 ◽  
Vol 10 (3) ◽  
pp. 13-29
Author(s):  
Elena V. Reznik ◽  
Semen Yu. Soltis ◽  
Dmitrii V. Ustiuzhanin ◽  
Igor G. Nikitin
Keyword(s):  
Heart Failure ◽  
Drug Therapy ◽  
Chronic Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular Systolic Dysfunction ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Number Of Patients ◽  
Optimal Drug

The prevalence of the chronic heart failure is increasing due to the success of cardiology and the increase in life expectancy of the population. A greater number of patients live up to the clinically pronounced stages of the chronic heart failure. This issue leads to an increasing in the absolute number of the patients in whom there is a lack of efficacy of optimally prescribed drug therapy. These patients are considering initiating cardiac resynchronization therapy (CRT). CRT is recommended for the patients with chronic heart failure II-IV functional class with severe left ventricular systolic dysfunction and prolonged QRS complex. Despite careful selection of patients for CRT implantation, the device does not lead to the expected result in one third of cases. To increase the effectiveness of this intervention, the procedure should be performed in accordance with current guidelines only for compliant patients who have been at least 3 months on selected optimal drug therapy, should use the optimal strategies and modes of stimulation and the adequate drug support after the intervention. The number of patients with long-term use of CRT is constantly growing. More and more patients with installed devices come into the field of vision of general practitioners and cardiologists of ambulatory clinics and hospitals, for whom it is extremely important to understand the specifics of the methods and tactics of managing such patients. This publication is dedicated to this.

Cardiac resynchronization therapy for patients with atrial fibrillation

2011 ◽  
Vol 152 (44) ◽  
pp. 1757-1763
Author(s):  
Attila Mihálcz ◽  
Pál Ábrahám ◽  
Attila Kardos ◽  
Csaba Földesi ◽  
Tamás Szili-Török
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Rate Control ◽  
Randomized Trials ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Patients With Heart Failure

Atrial fibrillation and chronic heart failure are two major and even growing cardiovascular conditions that often coexist. Cardiac resynchronization therapy is an important, device-based, non-pharmacological approach in a selected group of chronic heart failure patients that has been shown to improve left ventricular function and to reduce both morbidity and mortality in large randomized trials. The latest European and American guidelines have considered atrial fibrillation patients with heart failure eligible for cardiac resynchronization therapy. This review summarizes current literature concerning the following topics: prognostic relevance of atrial fibrillation in heart failure, effects of cardiac resynchronization therapy in atrial fibrillation, relevance and strategies of rhythm and rate control in this group of patients. Authors explain how atrial fibrillation may interfere with the delivery of adequate cardiac resynchronization therapy, how to reduce the burden of atrial tachyarrhythmias, and finally present a brief overview. Orv. Hetil., 2011, 152, 1757–1763.

The relationship between cardiac resynchronization therapy and serum levels of copeptin in patients with chronic heart failure

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Kerekanic ◽  
M Hudak ◽  
M Jakubova ◽  
D Kucerova ◽  
S Misikova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Systolic Dysfunction ◽  
Serum Levels ◽  
Left Ventricular ◽  
Public Institution ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Crt Response

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): The present study was supported by a grant from Slovak Hearth Rhythm Association (Prognostic value of MR-proANP and MR-proADM in patients undergoing cardiac resynchronization therapy). Background Chronic heart failure (CHF) is a complex syndrome characterized by an abnormal neurohormonal activation, including arginine vasopressin (AVP). Copeptin is an indicator of AVP activation, which levels are elevated in CHF and have prognostic importance. Cardiac resynchronization therapy (CRT) is an important device therapy for patients with advanced CHF, left ventricular (LV) systolic dysfunction and evidence of electromechanical dyssynchrony. The aim of the present study was to determine the possible relationship between CRT and serum copeptin levels. Methods We have included CRT patients with ischemic as well as nonischemic etiology of CHF. The levels of copeptin were measured at baseline and 12 months respectively after CRT implantation. Echocardiography was also performed pre and 12 months post CRT implantation. A CRT response was defined as a ≥ 15 % reduction in LV end-systolic volume (LVESV). Results The study population consisted of 41 patients. The mean copeptin level was 20.50 ± 15.77 pmol/l. Copeptin levels positively correlated with New York Heart Association class, left atrial diameter, creatinine levels and NT-proBNP levels. CRT responders have significant reduction in copeptin levels from baseline to 12 months (from 16.96 ± 12.80 pmol/l to 6.20 ± 6.44 pmol/l, p < 0.001). No significant changes in copeptin levels were observed in CRT nonresponders. Reduction > 45 % in copeptin levels was predictor of CRT-response (OR 6.72, 95 % CI 1.01 - 18.11, p = 0.045). Conclusion The copeptin serum levels can be a useful biomarker in the evaluation of the CRT response.

Electrocardiographic Model to Predict Cardiac Resynchronization Therapy Response among Chronic Heart Failure Patients

2020 ◽  
Vol 103 (10) ◽  
pp. 1091-1098
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Guideline Recommendation ◽  
Current Guideline ◽  
Resynchronization Therapy ◽  
Heart Failure Patients ◽  
Crt Response

Background: Despite contemporary restrictive clinical and electrocardiographic selection criteria, up to one-third of chronic heart failure patients with implanted cardiac resynchronization therapy (CRT) are non-responders. Previous studies reported that some electrocardiographic patterns, such as the longer the intrinsicoid deflection (ID) in lead I, the higher the R wave amplitude in V₆, and other patterns may be helpful for CRT response prediction. Objective: To establish a simplified model using electrocardiographic parameters as predictors of CRT response among chronic heart failure patients. Materials and Methods: Eighty chronic heart failure patients meeting the current guideline recommendation for CRT implantation were enrolled in the present retrospective cohort study. The patients’ clinical and electrocardiographic parameters at the time of CRT implantation and during follow-up were analyzed. The response to CRT was evaluated after six months of implantation, defined as a decrease in the left ventricular end systolic volume (LVESV) of 15% or more or an increase in the left ventricular ejection fraction (LVEF) of 10% or more. Results: During a median follow-up period of 34 months, there were 45 (56.3%) responders. In multivariate analysis, the independent predictors for CRT response were the greater the reduction of the QRS complex duration after implantation (QRS post – QRS pre), the higher the time to ID in the lead I/QRS ratio (ID I/QRS), and the higher the difference in the amplitude of the R and S waves in lead V₁ and V₆ [(S1+R6) – (S6+R1)] (QRS post – QRS pre: adjusted odds ratio [OR] 0.97, 95% CI 0.94 to 0.99, p=0.004; ID I/QRS: OR 18.65, 95% CI 1.02 to 342.64, p=0.049; (S1+R6) – (S6+R1): OR 1.1, 95% CI 1.04 to 1.17, p=0.002). The new equation for calculating the predictive CRT response model, generated from multiple logistic regression analysis, was –3.414 – 0.035(QRS post – QRS pre) + 2.926(ID I/QRS) + 0.097[(S1+R6) – (S6+R1)]. The area under the receiver operating characteristic (ROC) curve for the new model for predicting CRT response was 0.853 (95% CI 0.767 to 0.939). A model score of more than 0.3 showed a sensitivity of 85.7% and specificity of 80% for the prediction of CRT response. Conclusion: The new electrocardiographic model achieved a high sensitivity and specificity for the prediction of CRT response among chronic heart failure patients, who met the current guideline recommendation for CRT implantation. Keywords: Cardiac resynchronization therapy, Electrocardiography, Heart failure, Responders, Model

scholarly journals Effect of Cardiac Resynchronization Therapy on Left Ventricular Size and Function in Chronic Heart Failure

Circulation ◽  
2003 ◽  
Vol 107 (15) ◽  
pp. 1985-1990 ◽  
Author(s):  
Martin G. St John Sutton ◽  
Ted Plappert ◽  
William T. Abraham ◽  
Andrew L. Smith ◽  
David B. DeLurgio ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Ventricular Size ◽  
Resynchronization Therapy ◽  
Left Ventricular Size ◽  
And Function
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