Chapter

Cardiac resynchronization therapy

Badrinathan Chandrasekaran and Peter J. Cowburn

in Oxford Textbook of Heart Failure

Published on behalf of Oxford University Press

ISBN: 9780199577729
Published online July 2011 | e-ISBN: 9780199697809 | DOI: http://dx.doi.org/10.1093/med/9780199577729.003.0048

Series: Oxford Textbooks

Cardiac resynchronization therapy

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In the last decade, the use of cardiac resynchronization therapy(CRT), also known as biventricular pacing (BVP), has emerged as anew therapeutic option for selected patients with heart failure (HF)and ongoing symptoms despite optimal medical therapy who alsohave a prolonged QRS interval. CRT, by retiming the failing heart,improves symptoms, reduces hospitalization, and prolongs survivalin patients with left ventricular dysfunction and a broad QRScomplex. CRT improves electromechanical dyssynchrony and maximizes the efficiency of the cardiac contraction sequence, leading to an acute haemodynamic benefit and, over time, a reductionin left ventricular volumes and an improvement in left ventricularejection fraction (LVEF). A prolonged QRS width (> 120 ms) is a marker of benefit from CRT, with approximately 70% of suchpatients having symptomatic improvement following CRT. Cardiacresynchronization therapy can be delivered on its own as a pacemaker(CRT-P) or in addition to an internal cardiac defibrillator,where it is referred to as CRT-D. Advances in device technologyand telecommunications now enable remote monitoring of surrogatemarkers of HF, offering the ability to predict subclinical deterioration,and thereby potentially preventing HF hospitalization.

Chapter.  12875 words.  Illustrated.

Subjects: Cardiovascular Medicine

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