Cardiac Resynchroniztion Therapy In Heart Failure: Recent Advances And New Insights

Bhatia, V and Bhatia, R and Dhindsa, S and Virk, A (2003) Cardiac Resynchroniztion Therapy In Heart Failure: Recent Advances And New Insights. [Journal (Paginated)]

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Newer non-pharmacological therapies for heart failure are being evaluated for patients of congestive heart failure (CHF). Mechanical support with left ventricular assist devices and heart transplantation are reserved for the minority of patients who have severely decompensated heart failure1. Despite these therapeutic advances, it is generally accepted that current therapies do not adequately address the clinical need of patients with heart failure, and additional strategies are being developed. Cardiac resynchronization therapy (CRT) is a new modality that involves synchronization of ventricular contraction and has shown a lot of promise in managing symptomatic patients of CHF who are on optimal medical therapy and have interventricular conduction delay (IVCD). It has improved exercise tolerance and NYHA functional class in such patients in sinus rhythm and a recent meta-analysis has also shown mortality benefits in CHF. Recently benefits of CRT have also been observed in CHF patients who do not have wide QRS complexes on electrocardiogram (EKG). It has also been shown to benefit drug refractory angina in CHF. Recent studies have also focused on the combined use of CRT and implantable cardioverter defibrillator (ICD) and it has shown encouraging results. Our aim in this descriptive review is to define practice guidelines and to improve clinicians' knowledge of the available published clinical evidence, concentrating on few randomized controlled trials.

Item Type:Journal (Paginated)
Keywords:Cardiac Resynchroniztion Therapy; Heart Failure
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:4277
Deposited By: Indian Pacing and Electrophysiology, Journal
Deposited On:24 Apr 2005
Last Modified:11 Mar 2011 08:55

References in Article

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1. Rose EA, Gelijns AC, Moskowitz AJ, Heitjan DF, Stevenson LW, Dembitsky W, Long JW, Ascheim DD, Tierney AR, Levitan RG, Watson JT, Meier P, Ronan NS, Shapiro PA, Lazar RM, Miller LW, Gupta L, Frazier OH, Desvigne-Nickens P, Oz MC, Poirier VL. Long-term mechanical left ventricular assistance for end-stage heart failure. N Engl J Med. 2001;345:1435-43.

2. Leclercq C, Kass DA. Retiming the failing heart: principles and current clinical status of cardiac resynchronization. J Am Coll Cardiol. 2002;39:194-201.

3. Nelson GS, Berger RD, Fetics BJ, Talbot M, Spinelli JC, Hare JM, Kass DA. Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block. Circulation. 2000;102:3053-9.

4. Cappola TP, Kass DA, Nelson GS, Berger RD, Rosas GO, Kobeissi ZA, Marban E, Hare JM. Allopurinol improves myocardial efficiency in patients with idiopathic dilated cardiomyopathy. Circulation. 2001;104:2407-11.

5. Xiao HB, Roy C, Fujimoto S, Gibson DG. Natural history of abnormal conduction and its relation to prognosis in patients with dilated cardiomyopathy. Int J Cardiol. 1996;53:163-70.

6. Unverferth DV, Magorien RD, Moeschberger ML, Baker PB, Fetters JK, Leier CV. Factors influencing the one-year mortality of dilated cardiomyopathy. Am J Cardiol. 1984;54:147-52.

7. Shamim W, Francis DP, Yousufuddin M, Varney S, Pieopli MF, Anker SD, Coats AJ. Intraventricular conduction delay: a prognostic marker in chronic heart failure. Int J Cardiol. 1999;70:171-8

8. Brophy JM, Deslauriers G, Rouleau JL. Long-term prognosis of patients presenting to the emergency room with decompensated congestive heart failure. Can J Cardiol. 1994;10:543-7.

9. Kuhlkamp V. Initial experience with an implantable cardioverter-defibrillator incorporating cardiac resynchronization therapy. J Am Coll Cardiol. 2002;39:790-7.

10. Grines CL, Bashore TM, Boudoulas H, Olson S, Shafer P, Wooley CF. Functional abnormalities in isolated left bundle branch block. The effect of interventricular asynchrony. Circulation. 1989;79:845-53.

11. Farwell D, Patel NR, Hall A, Ralph S, Sulke AN. How many people with heart failure are appropriate for biventricular resynchronization? Eur Heart J. 2000;21:1246-50.

12. Erdogan A, Rueckleben S, Tillmanns HH, Waldecker B. Proportion of candidates for cardiac resynchronization therapy. Pacing Clin Electrophysiol. 2003;26:152-4.

13. Gras D, Cazeau S, Mabo P. Long-term benefit of cardiac resynchronization in heart failure patients: the 12 month results of the InSync trial (abstract). J Am Coll Cardiol. 2000;35:230A.

14. Gras D, Mabo P, Bucknall C. Responders and nonresponders to cardiac resynchronization therapy: Results from the InSync trial (abstract). J Am Coll Cardiol. 2000;35:230A.

15. Auricchio A, Stellbrink C, Sack S. Chronic benefit as a result of pacing in congestive heart failure: Results of the PATH CHF trial (abstract). J Card Fail. 1999;5 (3 Suppl 1):78.

16. 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. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346:1845-53.

17. Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, Garrigue S, Kappenberger L, Haywood GA, Santini M, Bailleul C, Daubert JC. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med. 2001;344:873-80.

18. Leclercq C, Walker S, Linde C, Clementy J, Marshall AJ, Ritter P, Djiane P, Mabo P, Levy T, Gadler F, Bailleul C, Daubert JC. Comparative effects of permanent biventricular and right-univentricular pacing in heart failure patients with chronic atrial fibrillation. Eur Heart J. 2002;23:1780-7.

19. Linde C, Leclercq C, Rex S, Garrigue S, Lavergne T, Cazeau S, McKenna W, Fitzgerald M, Deharo JC, Alonso C, Walker S, Braunschweig F, Bailleul C, Daubert JC. Long-term benefits of biventricular pacing in congestive heart failure: results from the MUltisite STimulation in cardiomyopathy (MUSTIC) study. J Am Coll Cardiol. 2002;40:111-8.

20. Williams ES, JM. M. Results from late-breaking clinical trial sessions at the American College of Cardiology 51st Annual Scientific Session. J Am Coll Cardiol. 2002;40. (abstract)

21. Daoud E, Hummel J, Higgins S, et al. Does ventricular resynchronization therapy influence total survival? Program and abstracts of the North American Society of Pacing and Electrophysiology 22nd Annual Scientific Sessions; May 2-5, 2001; Boston, Massachusetts. Abstract Session 1, Number 4.

22. Leclercq C, Alonso C, Revault D'allonnes F, Pavin D, Mabo P. Is the long-term benefit of biventricular

pacing in patients with advanced heart failure influenced by the baseline QRS duration? Program and abstracts of the North American Society of Pacing and Electrophysiology 22nd Annual Scientific Sessions; May 2-5, 2001; Boston, Massachusetts. Abstract Session 1, Number 6.

23. Saxon LA, Stevenson WG, Middlekauff HR, Stevenson LW. Increased risk of progressive hemodynamic deterioration in advanced heart failure patients requiring permanent pacemakers. Am Heart J. 1993;125:1306-10.

24. Leon AR, Greenberg JM, Kanuru N, Baker CM, Mera FV, Smith AL, Langberg JJ, DeLurgio DB. Cardiac resynchronization in patients with congestive heart failure and chronic atrial fibrillation: effect of upgrading to biventricular pacing after chronic right ventricular pacing. J Am Coll Cardiol. 2002;39:1258-63.

25. Auricchio A, Stellbrink C, Block M, Sack S, Vogt J, Bakker P, Klein H, Kramer A, Ding J, Salo R, Tockman B, Pochet T, Spinelli J. Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure. The Pacing Therapies for Congestive Heart Failure Study Group. The Guidant Congestive Heart Failure Research Group. Circulation. 1999;99:2993-3001.

26. Saxon LA, Kerwin WF, Cahalan MK, Kalman JM, Olgin JE, Foster E, Schiller NB, Shinbane JS, Lesh MD, Merrick SH. Acute effects of intraoperative multisite ventricular pacing on left ventricular function and activation/contraction sequence in patients with depressed ventricular function. J Cardiovasc Electrophysiol. 1998;9:13-21.

27. Leclercq C, Cazeau S, Le Breton H, Ritter P, Mabo P, Gras D, Pavin D, Lazarus A, Daubert JC. Acute hemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure. J Am Coll Cardiol. 1998;32:1825-31.

28. Cazeau S, Ritter P, Bakdach S, Lazarus A, Limousin M, Henao L, Mundler O, Daubert JC, Mugica J. Four chamber pacing in dilated cardiomyopathy. Pacing Clin Electrophysiol. 1994;17:1974-9.

29. Blanc JJ, Etienne Y, Gilard M, Mansourati J, Munier S, Boschat J, Benditt DG, Lurie KG. Evaluation of different ventricular pacing sites in patients with severe heart failure: results of an acute hemodynamic study. Circulation. 1997;96:3273-7.

30. Kass DA, Chen CH, Curry C, Talbot M, Berger R, Fetics B, Nevo E. Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation. 1999;99:1567-73.

31. Kerwin WF, Botvinick EH, O'Connell JW, Merrick SH, DeMarco T, Chatterjee K, Scheibly K, Saxon LA. Ventricular contraction abnormalities in dilated cardiomyopathy: effect of biventricular pacing to correct interventricular dyssynchrony. J Am Coll Cardiol. 2000;35:1221-7.

32. Kerwin WF FE, Paccanaro M, et al. Effect of chronic biventricular pacing on doppler measures of myocardial performance correlate with doppler measures of systolic function (abstract). Pacing Clin Electrophysiol;. 1999;22(Suppl):732

33. St John Sutton MG, Plappert T, Abraham WT, Smith AL, DeLurgio DB, Leon AR et al. Effect of Cardiac Resynchronization Therapy on Left Ventricular Size and Function in Chronic Heart Failure. Circulation 2003 Mar 31; [epub ahead of print].

34.. Breithardt OA, Sinha AM, Schwammenthal E, Bidaoui N, Markus KU, Franke A et al.Acute effects of cardiac resynchronization therapy on functional mitral regurgitation in advanced systolic heart failure. J Am Coll Cardiol 2003 Mar 5;41(5):765-70

35. Gasparini M, Mantica M, Galimberti P, Ceriotti C, Simonini S, Mangiavacchi M, Gronda E. Relief of drug refractory angina by biventricular pacing in heart failure. Pacing Clin Electrophysiol. 2003;26:181-4.

36. Kass DA CC, Curry C, et al. Improved left ventricular mechanics from acute vdd pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation. 1999;99:1567.

37. Auricchio A, Spinelli J. Cardiac resynchronization for heart failure: present status. Congest Heart Fail. 2000;6:325-329.

38. Saxon LA, De Marco T, Schafer J, Chatterjee K, Kumar UN, Foster E. Effects of long-term biventricular stimulation for resynchronization on echocardiographic measures of remodeling. Circulation. 2002;105:1304-10.

39. Saxon LA DT, Chatterjee K, et al. The magnitude of sympathoneural activation in advanced heart failure is altered with chronic biventricular pacing (abstract). Pacing Clin Electrophysiol. 1998;;21(Part II): 499.

40. Dibs SR KW, Godin G, et al. Chronic biventricular pacing does not worsen autonomic imbalance in heart failure (abstract). Pacing Clin Electrophysiol. 2000..

41. Yu CM, Chau E, Sanderson JE, Fan K, Tang MO, Fung WH, Lin H, Kong SL, Lam YM, Hill MR, Lau CP. Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation. 2002;105:438-45.

42. Abraham WT. Data from Multicenter InSync Randomized Clinical Evaluation (MIRACLE) presented at the American College of Cardiology 50th Annual Scientific Session, Orlando, Florida, 2001.

43. Stellbrink C, Breithardt OA, Franke A, Sack S, Bakker P, Auricchio A, Pochet T, Salo R, Kramer A, Spinelli J. Impact of cardiac resynchronization therapy using hemodynamically optimized pacing on left ventricular remodeling in patients with congestive heart failure and ventricular conduction disturbances. J Am Coll Cardiol. 2001;38:1957-65.

44. Williams ES, Miller JM. Results from late-breaking clinical trial sessions at the American College of Cardiology 51st Annual Scientific Session. J Am Coll Cardiol. 2002;40:1-18.

45. Gasparini M, Lunati M, Bocchiardo M, Mantica M, Gronda E, Frigerio M, Caponi D, Carboni A, Boriani G, Zanotto G, Ravazzi PA, Curnis A, Puglisi A, Klersy C, Vicini I, Cavaglia S. Cardiac resynchronization and implantable cardioverter defibrillator therapy: preliminary results from the InSync implantable cardioverter defibrillator italian registry. Pacing Clin Electrophysiol. 2003;26:148-51.

46. Bristow MR, Feldman AM, Saxon LA. Heart failure management using implantable devices for ventricular resynchronization: Comparison of Medical Therapy, Pacing, and Defibrillation in Chronic Heart Failure (COMPANION) trial. COMPANION Steering Committee and COMPANION Clinical Investigators. J Card Fail. 2000;6:276-85.

47. Higgins SL, Yong P, Sheck D, McDaniel M, Bollinger F, Vadecha M, Desai S, Meyer DB. Biventricular pacing diminishes the need for implantable cardioverter defibrillator therapy. Ventak CHF Investigators. J Am Coll Cardiol. 2000;36:824-7.

48. Gasparini M, Mantica M, Galimberti P, Bocciolone M, Genovese L, Mangiavacchi M, Marchesina UL, Faletra F, Klersy C, Coates R, Gronda E. Is the left ventricular lateral wall the best lead implantation site for cardiac resynchronization therapy? Pacing Clin Electrophysiol. 2003;26:162-8.

49. Ansalone G, Giannantoni P, Ricci R, Trambaiolo P, Fedele F, Santini M. Doppler myocardial imaging to evaluate the effectiveness of pacing sites in patients receiving biventricular pacing. J Am Coll Cardiol. 2002;39:489-99.

50. Ansalone G, Giannantoni P, Ricci R, Trambaiolo P, Laurenti A, Fedele F, Santini M. Doppler myocardial imaging in patients with heart failure receiving biventricular pacing treatment. Am Heart J. 2001;142:881-96.

51. Wilensky RL, Yudelman P, Cohen AI, Fletcher RD, Atkinson J, Virmani R, Roberts WC. Serial electrocardiographic changes in idiopathic dilated cardiomyopathy confirmed at necropsy. Am J Cardiol. 1988;62:276-83.

52. Baldasseroni S, Opasich C, Gorini M, Lucci D, Marchionni N, Marini M, Campana C, Perini G, Deorsola A, Masotti G, Tavazzi L, Maggioni AP. Left bundle-branch block is associated with increased 1-year sudden and total mortality rate in 5517 outpatients with congestive heart failure: a report from the Italian network on congestive heart failure. Am Heart J. 2002;143:398-405.

53. Gottipati V, Kralis S, Lu F. The Resting Electrocardiogram Provides a Sensitive and Inexpensive Marker of Prognosis in Patients with Chronic Congestive Heart Failure. (Abstract). J Am Coll Cardiol. 1999;33:145 A.

54. Nelson GS, Curry CW, Wyman BT, Kramer A, Declerck J, Talbot M, Douglas MR, Berger RD, McVeigh ER, Kass DA. Predictors of systolic augmentation from left ventricular preexcitation in patients with dilated cardiomyopathy and intraventricular conduction delay. Circulation. 2000;101:2703-9.

55. Aneslme F SI. Is QRS duration a good predictor of right to left ventricular asynchrony? Comparison with conventional Doppler and tissue Doppler imaging criteria. (abstract). PACE. 2002;25:528.

56. Garrigue S BH, Reuter S. QRS duration and morphology are not reliable parameters to identify heart failure patients with left ventricular dyssynchrony. An Echocardiographic Doppler Tissue Imaging Study. (abstract). PACE. 2002;25:547 A.

57. Yu CM,Lin H,Zhang Q. High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart 2003 Jan;89(1):54-60

58. Gasparini M, Galimberti P,Marconi M,Genovese L,Faltera F et al. Beneficial Effects of Biventricular Pacing in Patients with a Narrow QRS. PACE. 2003;26[pt.II]:169-174.

59. Cazeau S RP. Multisite pacing for end-stage heart failure: early experience. Pacing Clin Electrophysiol. 1996;Nov;19(11 Pt 2):1748-57.

60. Botvinick EH FM. An accurate means of detecting and characterizing abnormal patterns of ventricular activation by phase image analysis. Am J Cardiol. 1982;Aug;50(2):289-98.

61. Cazeau S, Bordachar P, Jauvert G, Lazarus A, Alonso C, Vandrell MC, Mugica J, Ritter P. Echocardiographic modeling of cardiac dyssynchrony before and during multisite stimulation: a prospective study. Pacing Clin Electrophysiol. 2003;26:137-43.

62. Burch GE, Giles TD, Colcolough HL. Ischemic cardiomyopathy. Am Heart J. 1970;79:291-2.

63. Littmann L, Symanski JD. Hemodynamic implications of left bundle branch block. J Electrocardiol. 2000;33 Suppl:115-21.

64. Gasparini M MM, Galimberti P, Genovese L, Pini D, Faletra F. Is the outcome of cardiac resynchronization therapy related to the underlying etiology. PACE. 2003;26[Pt. II]:175-180.

65. Saxon LA. Atrial fibrillation and dilated cardiomyopathy: therapeutic strategies when sinus rhythm cannot be maintained. Pacing Clin Electrophysiol. 1997;20:720-5.

66. Bradley DJ, Bradley EA, Baughman KL, Berger RD, Calkins H, Goodman SN et al. Cardiac resynchronization and death from progressive heart failure: a meta-analysis of randomized controlled trials. JAMA 2003 Feb 12;289(6):730-40.

67. Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS, Ganiats TG, Goldstein S, Gregoratos G, Jessup ML, Noble RJ, Packer M, Silver MA, Stevenson LW, Gibbons RJ, Antman EM, Alpert JS, Faxon DP, Fuster V, Jacobs AK, Hiratzka LF, Russell RO, Smith SC, Jr. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol. 2001;38:2101-13.

68. Hare JM. Cardiac-resynchronization therapy for heart failure. N Engl J Med. 2002;346:1902-5.

69. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346:877-83.


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