Summary
Cardiac resynchronization therapy (CRT) has significant positive effects on the quality of life, enables patients to cope more efficiently with cardiopulmonary stress and leads to a reduction of total mortality in patients suffering from congestive heart failure NYHA classes III and IV, reduced ventricular function and left bundle branch block with a QRS complex wider than 150 ms. In a large number of patients suited for CRT, an additional defibrillator function seems to work out well concerning an additional prognostic improvement by means of reducing sudden cardiac death. Due to partially contradictory study outcomes, it still remains to be discussed whether all patients suited for CRT really need an ICD.
Zusammenfassung
Die kardiale Resynchronisationstherapie (CRT) führt bei Patienten mit symptomatischer Herzinsuffizienz der NYHA-Stadien III und IV, eingeschränkter linksventrikulärer Funktion und Linksschenkelblock mit einer QRS-Breite >150 ms nicht nur zu einer signifikanten Verbesserung der kardiopulmonalen Belastbarkeit und der Lebensqualität, sondern auch zu einer Reduktion der Gesamtletalität. Eine zusätzliche Defibrillatorfunktion dürfte bei einer großen Zahl der für eine CRT geeigneten Patienten zu einer weiteren Prognoseverbesserung infolge Reduktion des plötzlichen Herztods führen. Ob alle Patienten, die für eine CRT in Betracht kommen, auch eines ICD bedürfen, muss aufgrund der teils noch widersprüchlichen Studienlage derzeit offen bleiben.
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References
Abraham WT, Fisher WG, Smith AL, Delurgio DB, Lern AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, Ellestad M. Messenger J for the MIRACLE Study Group (2002) Cardiac resynchronization in chronic heart failure. N Engl J Med 346:1845–1853
Auricchio A, Stellbrink C, Sack S, Block M, Vogt J, Bakker P, Huth C, Schöndube FA, Wolfhard U, Böcker D, Krahnefeld O, Kirkels H (2002) Chronic effects of hemodynamically optimized cardiac resynchronization therapy on patients with heart failure and ventricular conduction delay. J Am Coll Cardiol 39:2026–2033
Bansch D, Antz M, Boczor S et al (2002) Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy: the Cardiomyopathy Trial (CAT). Circulation 105:1453–1458
Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, Davidson-Ray LD, Fraulo ES, Fishbein DP, Luceri RM, Ip JH (2005) Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 352:225–237
Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, Di Carlo L, De Mets D, White BG, De Vries DW, Feldman AM for the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators (2004) Cardiac-Resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 350:2140–2150
Buxton AE, Lee KL, Fisher JD, Josephson ME, Prystovsky EN, Hafley G (1999) A randomized study of the prevention of sudden death in patients with coronary artery disease. The Multicenter Unsustained Tachycardia Trial Investigators. N Engl J Med 341:1882–1890
Daubert JC, Linde C, Cazeau S, Kappenberger L, Sutton R, Bailleul C (2000) Clinical effects of biventricular pacing in patients with severe heart failure and chronic atrial fibrillation: results from themultisite stimulation in cardiomyopathy—MUSTIC study—group II. Circulation 102(Suppl II):3349 (abstr)
Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, Garrigue S, Kappenberger L, Haywood GA, Santini M, Bailleul C, Daubert JC for the Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigators (2001) Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 344:873–880
Cleland JGF, Daubert J-C, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L for the Cardiac Resynchronization—Heart Failure (CARE-HF) Study Investigators (2005) The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 352:1539–1549
Kadish A, Dyer A, Daubert JP, Quigg R, Estes NAM, Anderson KP, Calkins H, Hoch D, Goldberger J, Shalaby A, Sanders WE, Schaechter A, Levine JH (2004) Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med 305:2151–2158
Kühlkamp V, and In Syne 7272 ICD World Wide Investigators (2002) Initial experience with an implantable cardioverter-defibrillator incorporating cardiac resynchronization therapy. J Am Coll Cardiol 39:790–797
Lemke B, Nowak B, Pfeiffer D (2005) Leitlinien zur Herzschrittmachertherapie. Z Kardiol 94:704–720
MERIT-HF Study Group (1999) Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomizid Intervention Trial In Congestive Heart Failure (MERIT-HF). Lancet 353:2001–2007
Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, Levine JH, Saksena S, Waldo AL, Wilber D, Brown MW, Heo M (1996) Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 335:1933–1940
Moss AJ, Zareba W, Hall J, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346:877–883
Stellbrink C, Auricchio A, Lemke B, von Scheidt W, Vogt J (2003) Positionspapier zur kardialen Resynchronisationstherapie. Z Kardiol 92:96–103
Strickberger SA, Hummel JD, Bartlett TG, Frumin HI, Schuger CD, Beau SL, Bitar C, Morady F for the AMIOVIRT Investigators (2003) Amiodaron versus implantable cardioverter-defibrillator: randomized trial in patients with nonischemic dilated cardiomyopathy and asymptomatic nonsustained ventricular tachycardia—AMIOVIRT. J Am Coll Cardiol 41:1707–1712
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Volkmann, H., Bergmann, C. & Walter, M. Kardiale Resynchronisation: Wer ist geeignet?—. ZS Kardiologie 94 (Suppl 4), iv60–iv64 (2005). https://doi.org/10.1007/s00392-005-1414-8
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DOI: https://doi.org/10.1007/s00392-005-1414-8