Abstract
Cardiac resynchronization therapy (CRT) is one of the major advances in the treatment of patients with chronic heart failure due to impaired left ventricular ejection fraction. Current guidelines recommend with the highest levels of recommendation and evidence CRT in patients with low ejection fraction wide QRS, LBBB, and mild to severe heart failure (New York Heart Association class II to IV). However, other patients might benefit from CRT. This is the case for patients with permanent atrial fibrillation, patients conventional pacemaker indication, patients with mildly impaired left ventricular function (>35 %), or asymptomatic patients (NYHA I). We will discuss in this manuscript each new potential indication for CRT.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
• Holzmeister J, Leclercq C. Implantable cardioverter defibrillators and cardiac resynchronization therapy. Lancet. 2011;378:722–30. This review provides an update summary of role the electrical device in heart failure..
Daubert C, Gold MR, Abraham WT, et al. 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. J Am Coll Cardiol. 2009;54:1837–46.
Moss AJ, Hall WJ, Cannom DS, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009;361:1329–38.
Tang A, Wells G, Talajic P, et al. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med. 2010;363:2385–95.
Indications for Cardiac Resynchronization Therapy. 2011 Update from the Heart Failure Society of America Guideline Committee. J Cardiac Fail. 2012;18:94–106.
•• ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012. On line. This manuscript depicts clearly the indication (and non indications) for CRT.
•• Dickstein K, Bogale N, Priori S, Auricchio A, Cleland JG, Gitt A, et al. The European cardiac resynchronization survey. Eur Heart J. 2009;30:2450–60. This manuscript depicts clearly the indication (and non indications) for CRT..
Gasparini M, Auricchio A, Metra M, Regoli F, Fantoni C, Lamp B, Multicentre Longitudinal Observational Study (MILOS) Group, et al. Long-term survival in patients undergoing cardiac resynchronization therapy: the importance of performing atrio-ventricular junction ablation in patients with permanent atrial fibrillation. Eur Heart J. 2008;29:1644–52.
Fein AS, Wang Y, Curtis JP, Masoudi FA, Varosy PD, Reynolds MR. National Cardiovascular Data Registry. Prevalence and predictors of off-label use of cardiac resynchronization therapy in patients enrolled in the National Cardiovascular Data Registry Implantable Cardiac-Defibrillator Registry. J Am Coll Cardiol. 2010;56:766–73.
Leclercq C, Walker S, Linde C, et al. Comparative effects of permanent biventricular and right-univentricular pacing in HF failure patients with chronic atrial fibrillation. Eur Heart J. 2002;23:1780–7.
Brignole M, Botto G, Mont L, Iacopino S, De Marchi G, Oddone D, et al. Cardiac resynchronization therapy in patients undergoing atrioventricular junction ablation for permanent atrial fibrillation: a randomized trial. Eur Heart J. 2011;32:2420–9.
Upadhyay GA, Choudhry NK, Auricchio A, Ruskin J, Singh JP. Cardiac resynchronization in patients with atrial fibrillation: a meta-analysis of prospective cohort studies. J Am Coll Cardiol. 2008;52:1239–46.
Wilton SB, Leung AA, Ghali WA, Faris P, Exner DV. Outcomes of cardiac resynchronization therapy in patients with versus those without atrial fibrillation: a systematic review and meta-analysis. Heart Rhythm. 2011;8:1088–94.
Linde C, Leclercq C, Rex S, Garrigue S, Lavergne T, Cazeau S, et al. 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.
Doshi RN, Daoud EG, Fellows C, Turk K, Duran A, Hamdan MH, et al. Left ventricular-based cardiac stimulation post AV Nodal ablation evaluation (the PAVE study). J Cardiovasc Electrophysiol. 2005;16:1160–5.
Wein S, Voskoboinik A, Wein L, Billah B, Krum H. Extending the boundaries of cardiac resynchronization therapy: efficacy in atrial fibrillation, NHYA class II, and narrow QRS heart failure patients. J Cardiac Fail. 2010;16:432–8.
Koplan BA, Kaplan AJ, Weiner S, Jones PW, Seth M, Christman SA. Heart failure decompensation and all-cause mortality in relation to percent biventricular pacing in patients with heart failure: is a goal of 100 % biventricular pacing necessary? J Am Coll Cardiol. 2009;53:355–60.
Hayes DL, Boehmer JP, Day JD, Gilliam III FR, Heidenreich PA, Jones PW, et al. Cardiac resynchronization therapy and the relationship of percent biventricular pacing to symptoms and survival. Heart Rhythm. 2011;8:1469–75.
Tolosana JM, Hernandez Madrid A, Brugada J, Sitges M, Garcia Bolao I, Fernandez Lozano I, et al. Comparison of benefits and mortality in cardiac resynchronization therapy in patients with atrial fibrillation versus patients in sinus rhythm (Results of the Spanish Atrial Fibrillation and Resynchronization [SPARE] Study). Am J Cardiol. 2008;102:444–9.
Leclercq C, Victor F, Alonso C, Pavin D, Revault d’Allones G, Bansard JY, et al. Comparative effects of permanent biventricular and right-univentricular pacing in heart failure patients with chronic atrial fibrillation. Eur Heart J. 2002;23:1780–7.
Molhoek SG, Bax JJ, Bleeker GB, Boersma E, van Erven L, Steendijk P, et al. Comparison of response to cardiac resynchronization therapy in patients with sinus rhythm versus chronic atrial fibrillation. Am J Cardiol. 2004;94:1506–9.
Gasparini M, Aurichio A, Regoli F, Fantoni C, Kawabata M, Galimberti P, et al. Four-year efficacy of cardiac resynchronization therapy on exercise tolerance and disease progression: the importance of performing atrioventricular junction ablation in patients with atrial fibrillation. J Am Coll Cardiol. 2006;48:734–43.
Gasparini M, Auricchio A, Metra M, Regoli F, Fantoni C, Lamp B, et al. Long-term survival in patients undergoing cardiac resynchronisation therapy: the importance of atrio-ventricular junction ablation in patients with permanent atrial fibrillation. Eur Heart J. 2008;29:1644–52.
Ferreira AM, Adragão P, Cavaco DM, Candeias R, Morgado FB, Santos KR, et al. Benefit of cardiac resynchronization therapy in atrial fibrillation patients vs. patients in sinus rhythm: the role of atrioventricular junction ablation. Europace. 2008;10:809–15.
Delnoy PP, Ottervanger JP, Luttikhuis HO, Elvan A, Misier AR, Beukema WP, et al. Comparison of usefulness of cardiac resynchronization therapy in patients with atrial fibrillation and heart failure versus patients with sinus rhythm and heart failure. Am J Cardiol. 2007;99:1252–7.
Khadjooi K, Foley PW, Chalil S, et al. Long-term effects of cardiac resynchronization therapy in patients with atrial fibrillation. Heart. 2008;94:879–83.
Orlov MV, Gardin JM, Slawsky M, Bess RL, Cohen G, Bailey W, et al. Biventricular pacing improves cardiac function and pre-vents further left atrial remodeling in patients with symptomatic atrial fibrillation after atrioventricular node ablation. Am Heart J. 2010;159:264–70.
van Geldorp IE, Vernooy K, Delhaas T, Prins MH, Crijns HJ, Prinzen FW, et al. Beneficial effects of biventricular pacing in chronically right ventricular paced patients with mild cardiomyopathy. Europace. 2010;12:223–9.
Delnoy PP, Ottervanger JP, Vos DH, Elvan A, Misier AR, Beukema WP, et al. Upgrading to biventricular pacing guided by pressure-volume loop analysis during implantation. J Cardiovasc Electrophysiol. 2011;22:677–83.
Leon AR, Greenberg JM, Kanuru N, et al. 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.
Baker CM, Christopher TJ, Smith PF, Langberg JJ, DeLurgio DB, Leon AR. Addition of a left ventricular lead to conventional pacing systems in patients with congestive heart failure: feasibility, safety, and early results in 60 consecutive patients. Pacing Clin Electrophysiol. 2002;25:1166–71.
Valls-Bertault V, Fatemi M, Gilard M, Pennec PY, Etienne Y, Blanc JJ. Assessment of upgrading to biventricular pacing in patients with right ventricular pacing and congestive heart failure after atrioventricular junctional ablation for chronic atrial fibrillation. Europace. 2004;6:438–43.
Eldadah ZA, Rosen B, Hay I, et al. The benefit of upgrading chronically right ventricle-paced heart failure patients to resynchronization therapy demonstrated by strain rate imaging. Heart Rhythm. 2006;3:435–42.
Leclercq C, Cazeau S, Lellouche D, et al. Upgrading from single chamber right ventricular to biventricular pacing in permanently paced patients with worsening heart failure: the RD-CHF study. Pacing Clin Electrophysiol. 2007;30 Suppl 1:S23–30.
Laurenzi F, Achilli A, Avella A, et al. Biventricular pacing in patients with conventional pacing system and congestive heart failure: results and response predictors. Pacing Clin Electrophysiol. 2007;30:1096–104.
Vatankulu MA, Goktekin O, Kaya MG, Ayhan S, Kucukdurmaz Z, Sutton R, et al. Effect of long-term resynchronization therapy on left ventricular remodeling in pacemaker patients upgraded to biventricular devices. Am J Cardiol. 2009;103:1280–4.
Marai I, Gurevitz O, Carasso S, et al. Improvement of congestive heart failure by upgrading of conventional to resynchronization pacemakers. Pacing Clin Electrophysiol. 2006;29:880–4.
Foley PW, Muhyaldeen SA, Chalil S, Smith RE, Sanderson JE, Leyva F. Long-term effects of upgrading from right ventricular pacing to cardiac resynchronization therapy in patients with heart failure. Europace. 2009;1:495–501.
Paparella G, Sciarra L, Capulzini L, Francesconi A, De Asmundis C. Long-term effects of upgrading to biventricular pacing: differences with cardiac resynchronization therapy as primary indication. Pacing Clin Electrophysiol. 2010;33:841–9.
Fröhlich G, Steffel J, Hürlimann D, Enseleit F, Lüscher TF, Ruschitzka F. Upgrading to resynchronization therapy after chronic right ventricular pacing improves left ventricular remodelling. Eur Heart J. 2010;31:1477–85.
Bogale N, Witte K, Priori S, Auricchio A, Cleland J, Gitt A, et al. Comparison between upgraded and de-novo cardiac resynchronization therapy implantations: European CRT Survey on behalf of the Scientific Committee, National coordinators and the investigators. Eur J Heart Fail. 2011;13:974–84.
Kindermann M, Hennen B, Jung J, Geisel J, Bohm M, Frohlig G. Biventricular versus conventional right ventricular stimulation for patients with standard pacing indication and left ventricular dysfunction: the Homburg Biventricular Pacing Evaluation (HOBIPACE). J Am Coll Cardiol. 2006;47:1927–37.
Albertsen AE, Nielsen JC, Poulsin SH, Mortensen PT, Pedersen AK, Hansen PS, et al. Biventricular pacing preserves left ventricular performance in patients with high-grade atrio-ventricular block: a randomized comparison with DDD(R) pacing in 50 consecutive patients. Europace. 2008;10:314–20.
Yu CM, Chan J, Zhang Q, Omar R, Yip G, Hussin A, et al. Biventricular pacing in patients with bradycardia and normal ejection fraction. N Engl J Med. 2009;361:2123–34.
Chan JY, Fang F, Zhang Q, Fung JW, Razali O, Azlan H, et al. Biventricular pacing is superior to right ventricular pacing in bradycardia patients with preserved systolic function: 2-year results of the PACE trial. Eur Heart J. 2011;32:2533–40.
Stockburger M, Gomez-doblas JJ, Lamas G, Alzueta J, Lozano I, Cobo E, et al. Preventing ventricular dysfunction in pacemaker patients without advanced heart failure: results from a multicentre international randomized trial (PREVENT-HF). Eur J Heart Fail. 2011;13:633–41.
Curtis AB, Adamson PB, Chung E, St John Sutton M, Tang F, Worley S. Biventricular versus right ventricular pacing in patients with AV block (BLOCK HF): clinical study design and rationale. J Cardiovasc Electrophysiol. 2007;18:965–71.
Funck RC, Blanc JJ, Mueller HH, On behalf of the BioPace Study Group, et al. Biventricular stimulation to prevent cardiac desynchronization: rationale, design, and endpoints of the “Biventricular Pacing for Atrioventricular Block to Prevent Cardiac Desynchronization (BioPace)” study. Europace. 2006;8:629–35.
Fung JW, Zhang Q, Yip GW, Chan JY, Chan HC, Yu CM. Effect of cardiac resynchronization therapy in patients with moderate left ventricular systolic dysfunction and wide QRS complex: a prospective study. J Cardiovasc Electrophysiol. 2006;17:1288–92.
Chung ES, Katra RP, Ghio S, et al. Cardiac resynchronization therapy may benefit patients with left ventricular ejection fraction >35 %: a PROSPECT trial substudy. Eur J Heart Fail. 2010;12:581–7.
Fonarow GC, Stough WG, Abraham WT, et al. Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF Registry. J Am Coll Cardiol. 2007;50:768–77.
Donal E, Thebault C, Lund LH et al. Heart failure with a preserve ejection fraction additive value of an exercise stress echocardiography. Eur Heart J Cardiovasc Imaging. 2012. On line
Achilli A, Sassara M, Ficili S, et al. Long-term effectiveness of cardiac resynchronization therapy in patients with refractory heart failure and narrow QRS. J Am Coll Cardiol. 2003;42:2117–24.
Bleeker GB, Holman ER, Steendijk P, et al. Cardiac resynchronization therapy in patients with a narrow QRS complex. J Am Coll Cardiol. 2006;48:2243–50.
Yu CM, Chan YS, Zhang Q, et al. Benefits of cardiac resynchronization therapy for heart failure patients with narrow QRS complexes and coexisting systolic asynchrony by echocardiography. J Am Coll Cardiol. 2006;48:2251–7.
Beshai JF, Grimm RA, Nagueh SF, et al. Cardiac-resynchronization therapy in heart failure with narrow QRS complexes. N Engl J Med. 2007;357:2461–71.
Holzmeister J, Hurlimann D, Steff el J, Ruschitzka F. Cardiac resynchronization therapy in patients with a narrow QRS. Curr Heart Fail Rep. 2009;6:49–56.
Disclosure
Conflicts of interest: C. Leclercq: has been a consultant for and received honoraria from SJM; Medtronic, BSI and SORIN; N. Behar: none; P. Mabo: none; J.-C. Daubert: none.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Leclercq, C., Behar, N., Mabo, P. et al. Expanding Indications for Resynchronization Therapy. Curr Cardiol Rep 14, 540–546 (2012). https://doi.org/10.1007/s11886-012-0299-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11886-012-0299-1