Congestive heart failure biventricular pacing or cardiac resynchronization therapy: Difference between revisions

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{{Congestive heart failure}}
#redirect:[[Cardiac resynchronization therapy]]
 
'''Editor(s)-In-Chief:''' James Chang, M.D., Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School [mailto:jchang@caregroup.org] and [[User:C Michael Gibson|C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org], Cardiovascular Division Beth Israel Deaconess Medical Center, Boston MA, Harvard Medical School
 
==Overview==
* Cardiac resynchronization therapy should only be undertaken if the blood pressure is low and if the heart failure medicines have been optimized
* CRT is indicated for symptomatic patients with NYHA III-IV heart failure and wide QRS complex (>120ms) who are him normal sinus rhythm.
* 70% of patients receiving synchronous ventricular contraction report significant symptomatic improvements.
 
==Indications for Cardiac Resynchronization Therapy==
 
1. The [[left ventricular ejection fraction]] ([[LVEF]]) is ≤ 35%
 
'''''and'''''
 
2. There is evidence of [[left bundle branch block]] ([[LBBB]]) or QRS ≥ 120 msec
 
'''''and'''''
 
3. Left ventricular end-diastolic diamter (LVEDD) ≥ 5.5 cms
 
===Background===
*[[Cardiac resynchronization therapy]] ([[CRT]]) is recommended for all patients with [[LVEF]] ≤ 35%, dilated LV (LVEDD > 5.5 cm), [[left bundle branch block]] (QRS duration > 120 msec), and [[sinus rhythm]]. CRT improves functional status and decreases mortality in the majority of these patients.
 
*In the REVERSE<ref name="pmid19800193">{{cite journal |author=Daubert C, Gold MR, Abraham WT, Ghio S, Hassager C, Goode G, Szili-Török T, Linde C |title=Prevention of disease progression by cardiac resynchronization therapy in patients with asymptomatic or mildly symptomatic left ventricular dysfunction: insights from the European cohort of the REVERSE (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction) trial |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=20 |pages=1837–46 |year=2009 |month=November |pmid=19800193 |doi=10.1016/j.jacc.2009.08.011 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)02759-4 |accessdate=2012-04-03}}</ref> and MADIT-CRT<ref name="pmid19723701">{{cite journal |author=Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, Estes NA, Foster E, Greenberg H, Higgins SL, Pfeffer MA, Solomon SD, Wilber D, Zareba W |title=Cardiac-resynchronization therapy for the prevention of heart-failure events |journal=[[The New England Journal of Medicine]] |volume=361 |issue=14 |pages=1329–38 |year=2009 |month=October |pmid=19723701 |doi=10.1056/NEJMoa0906431 |url=http://dx.doi.org/10.1056/NEJMoa0906431 |accessdate=2012-04-03}}</ref> trials patients with [[NYHA classification|NYHA I or II]] had decreased heart failure events and increased reverse remodeling of the left ventricle. This is not yet an ''AHA guideline'' but should be considered in this group of patients based on the available evidence.
 
==ACC/AHA Guidelines- Cardiac Resynchronization (DO NOT EDIT)<ref name="pmid18483207">{{cite journal |author=Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW |title=ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons |journal=[[Circulation]] |volume=117 |issue=21 |pages=e350–408 |year=2008 |month=May |pmid=18483207 |doi=10.1161/CIRCUALTIONAHA.108.189742 |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=18483207 |issn= |accessdate=2011-01-15}}</ref>==
{{cquote|
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]====
 
'''1.'''  Patients with [[left ventricular ejection fraction]] ([[LVEF]]) of less than or equal to 35%, sinus rhythm, and [[New york heart association functional classification|NYHA functional class III or ambulatory class IV]] symptoms despite recommended, optimal medical therapy and who have cardiac dyssynchrony, which is currently defined as a QRS duration greater than or equal to 0.12 seconds, should receive [[cardiac resynchronization therapy]], with or without an [[implantable cardioverter defibrillator]] ([[ICD]]), unless contraindicated.<ref name="pmid17986493">{{cite journal |author=Beshai JF, Grimm RA, Nagueh SF, Baker JH, Beau SL, Greenberg SM, Pires LA, Tchou PJ |title=Cardiac-resynchronization therapy in heart failure with narrow QRS complexes |journal=[[The New England Journal of Medicine]] |volume=357 |issue=24 |pages=2461–71 |year=2007 |month=December |pmid=17986493 |doi=10.1056/NEJMoa0706695 |url=http://dx.doi.org/10.1056/NEJMoa0706695 |accessdate=2012-04-05}}</ref><ref name="pmid15753115">{{cite journal |author=Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L |title=The effect of cardiac resynchronization on morbidity and mortality in heart failure |journal=[[The New England Journal of Medicine]] |volume=352 |issue=15 |pages=1539–49 |year=2005 |month=April |pmid=15753115 |doi=10.1056/NEJMoa050496 |url=http://dx.doi.org/10.1056/NEJMoa050496 |accessdate=2012-04-05}}</ref><ref name="pmid14563591">{{cite journal |author=Higgins SL, Hummel JD, Niazi IK, Giudici MC, Worley SJ, Saxon LA, Boehmer JP, Higginbotham MB, De Marco T, Foster E, Yong PG |title=Cardiac resynchronization therapy for the treatment of heart failure in patients with intraventricular conduction delay and malignant ventricular tachyarrhythmias |journal=[[Journal of the American College of Cardiology]] |volume=42 |issue=8 |pages=1454–9 |year=2003 |month=October |pmid=14563591 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109703010428 |accessdate=2012-04-05}}</ref><ref name="pmid8682602">{{cite journal |author=Xiao HB, Roy C, Fujimoto S, Gibson DG |title=Natural history of abnormal conduction and its relation to prognosis in patients with dilated cardiomyopathy |journal=[[International Journal of Cardiology]] |volume=53 |issue=2 |pages=163–70 |year=1996 |month=February |pmid=8682602 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/0167527395025022 |accessdate=2012-04-05}}</ref><ref name="pmid10454306">{{cite journal |author=Shamim W, Francis DP, Yousufuddin M, Varney S, Pieopli MF, Anker SD, Coats AJ |title=Intraventricular conduction delay: a prognostic marker in chronic heart failure |journal=[[International Journal of Cardiology]] |volume=70 |issue=2 |pages=171–8 |year=1999 |month=July |pmid=10454306 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0167-5273(99)00077-7 |accessdate=2012-04-05}}</ref><ref name="pmid6741806">{{cite journal |author=Unverferth DV, Magorien RD, Moeschberger ML, Baker PB, Fetters JK, Leier CV |title=Factors influencing the one-year mortality of dilated cardiomyopathy |journal=[[The American Journal of Cardiology]] |volume=54 |issue=1 |pages=147–52 |year=1984 |month=July |pmid=6741806 |doi= |url= |accessdate=2012-04-05}}</ref><ref name="pmid9396415">{{cite journal |author=Blanc JJ, Etienne Y, Gilard M, Mansourati J, Munier S, Boschat J, Benditt DG, Lurie KG |title=Evaluation of different ventricular pacing sites in patients with severe heart failure: results of an acute hemodynamic study |journal=[[Circulation]] |volume=96 |issue=10 |pages=3273–7 |year=1997 |month=November |pmid=9396415 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=9396415 |accessdate=2012-04-05}}</ref><ref name="pmid10096932">{{cite journal |author=Kass DA, Chen CH, Curry C, Talbot M, Berger R, Fetics B, Nevo E |title=Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay |journal=[[Circulation]] |volume=99 |issue=12 |pages=1567–73 |year=1999 |month=March |pmid=10096932 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10096932 |accessdate=2012-04-05}}</ref><ref name="pmid11139911">{{cite journal |author=Toussaint JF, Lavergne T, Ollitraut J, Hignette C, Darondel JM, De Dieuleveult B, Froissart M, Le Heuzey JY, Guize L, Paillard M |title=Biventricular pacing in severe heart failure patients reverses electromechanical dyssynchronization from apex to base |journal=[[Pacing and Clinical Electrophysiology : PACE]] |volume=23 |issue=11 Pt 2 |pages=1731–4 |year=2000 |month=November |pmid=11139911 |doi= |url= |accessdate=2012-04-05}}</ref><ref name="pmid11120694">{{cite journal |author=Nelson GS, Berger RD, Fetics BJ, Talbot M, Spinelli JC, Hare JM, Kass DA |title=Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block |journal=[[Circulation]] |volume=102 |issue=25 |pages=3053–9 |year=2000 |month=December |pmid=11120694 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=11120694 |accessdate=2012-04-05}}</ref><ref name="pmid12063368">{{cite journal |author=Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, Ellestad M, Trupp RJ, Underwood J, Pickering F, Truex C, McAtee P, Messenger J |title=Cardiac resynchronization in chronic heart failure |journal=[[The New England Journal of Medicine]] |volume=346 |issue=24 |pages=1845–53 |year=2002 |month=June |pmid=12063368 |doi=10.1056/NEJMoa013168 |url=http://dx.doi.org/10.1056/NEJMoa013168 |accessdate=2012-04-05}}</ref><ref name="pmid12771115">{{cite journal |author=Young JB, Abraham WT, Smith AL, Leon AR, Lieberman R, Wilkoff B, Canby RC, Schroeder JS, Liem LB, Hall S, Wheelan K |title=Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial |journal=[[JAMA : the Journal of the American Medical Association]] |volume=289 |issue=20 |pages=2685–94 |year=2003 |month=May |pmid=12771115 |doi=10.1001/jama.289.20.2685 |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=12771115 |accessdate=2012-04-05}}</ref><ref name="pmid15312864">{{cite journal |author=McAlister FA, Stewart S, Ferrua S, McMurray JJ |title=Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials |journal=[[Journal of the American College of Cardiology]] |volume=44 |issue=4 |pages=810–9 |year=2004 |month=August |pmid=15312864 |doi=10.1016/j.jacc.2004.05.055 |url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(04)01123-4 |accessdate=2012-04-05}}</ref><ref name="pmid15152059">{{cite journal |author=Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM |title=Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure |journal=[[The New England Journal of Medicine]] |volume=350 |issue=21 |pages=2140–50 |year=2004 |month=May |pmid=15152059 |doi=10.1056/NEJMoa032423 |url=http://dx.doi.org/10.1056/NEJMoa032423 |accessdate=2012-04-05}}</ref><ref name="pmid12419298">{{cite journal |author=Leclercq C, Walker S, Linde C, Clementy J, Marshall AJ, Ritter P, Djiane P, Mabo P, Levy T, Gadler F, Bailleul C, Daubert JC |title=Comparative effects of permanent biventricular and right-univentricular pacing in heart failure patients with chronic atrial fibrillation |journal=[[European Heart Journal]] |volume=23 |issue=22 |pages=1780–7 |year=2002 |month=November |pmid=12419298 |doi= |url= |accessdate=2012-04-05}}</ref><ref name="pmid11955841">{{cite journal |author=Leon AR, Greenberg JM, Kanuru N, Baker CM, Mera FV, Smith AL, Langberg JJ, DeLurgio DB |title=Cardiac resynchronization in patients with congestive heart failure and chronic atrial fibrillation: effect of upgrading to biventricular pacing after chronic right ventricular pacing |journal=[[Journal of the American College of Cardiology]] |volume=39 |issue=8 |pages=1258–63 |year=2002 |month=April |pmid=11955841 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0735109702017795 |accessdate=2012-04-05}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]====
 
'''1.''' For patients who have LVEF less than or equal to 35%, a QRS duration greater than or equal to 0.12 seconds, and AF, CRT with or without an ICD is reasonable for the treatment of NYHA functional Class III or ambulatory Class IV heart failure symptoms on optimal recommended medical therapy. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])
 
'''2.''' For patients with LVEF less than or equal to 35% with NYHA functional Class III or ambulatory Class IV symptoms who are receiving optimal recommended medical therapy and who have frequent dependence on ventricular pacing, CRT is reasonable. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])
 
====[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]====
 
'''1.''' For patients with LVEF less than or equal to 35% with NYHA functional Class I or II symptoms who are receiving optimal recommended medical therapy and who are undergoing implantation of a permanent pacemaker and/or ICD with anticipated frequent ventricular pacing, CRT may be considered. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])}}
 
==References==
{{Reflist|2}}
 
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