Abstract
Cardiac resynchronization therapy (CRT) improves symptoms, exercise performance, ventricular function, and survival in patients with left ventricular dysfunction, prolonged QRS, and drug-refractory moderate to severe CHF. The growing application of CRT has created a large number of patients with complicated devices that need follow-up care from general practitioners, cardiologists, heart failure specialists and electrophysiologists. Optimal care of the CRT patient includes recognition and management of peri-implantation complications, optimal programming of atrio-ventricular and sequential ventricular timing, and troubleshooting device-related problems during long-term follow-up. A basic awareness of fundamental device features, the techniques to maximize the response to CRT, and an understanding of stored device data to track the response to therapy provide clinicians the ability to maximize clinical outcomes in the CHF patient. As evolving technology continues to increase the complexity of device therapies, clinicians must understand these therapies in order to properly treat heart failure patients. This work summarizes many of the issues involving early complications of CRT device implant, the strategies to optimize device function, and suggests a scheme for follow-up care of patients with CRT devices.
Similar content being viewed by others
References
Abraham WT, Fisher WG, Smith AL, DeLurgio DB, Leon AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, Ellested M, Trupp RJ, Underwood J, Pickering F, Truex C, McAtee P, Messenger J. Cardiac resynchronization in chronic heart failure. N Engl J Me 2002;346(24):1845–1853.
Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, Garrigue S, Kappenberger L, Haywood G, Santini M, Bailleul C, Mabo P, Lazarus A, Ritter P, Levy T, McKenna W, Daubert JC. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Me 2001;344(12):873–880.
Linde C, Leclerq C, Rex S, Garrigue S, Lavergne T, Cazeau S, McKenna W, Fitzgerald M, Deharo JC, Alonso C, Walker S, Braunschweig F, Baailleul C, Daubert JC. Long-Term Benefits of Biventricular Pacing in Congestive Heart Failure:Results of the Multisite Stimulation in cardiomyopathy (MUSTIC) study. J Am Coll Cardio 2002;40(1):111–118.
Young JB, Abraham WT, Smith AL, Leon AR, Lieberman R, Wilkoff B, Canby RC, Schroeder JS, Liem LB, Hall S, Wheelan K for the Multicenter InSync ICD Randomized Clinical Evaluation (MIRACLE ICD) Trial Investigators. Combined Cardiac Resynchronization and Implantable Cardioversion Defibrillation in Advanced Chronic Heart Failure:The MIRACL ICD trial. J Am Med Asso 2003:289:2685–2694.
Auricchio A, Stellbrink C, Sack S, Block M, Vogt J, Bakker P, Huth C, Schondube F, Wolfhard U, Bocker D, Krahnefeld H, for the Pacing Therapies in Congestive Heart Failure (PATH-CHF) Study Group. Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J Am Coll Cardio 2002;39:2026–2033.
John GF, Cleland, Jean-Claude Daubert, Erland Erdmann, Nick Freemantle, Daniel Gras, Lukas Kappenberger, Luigi Tavazzi, for the Cardiac Resynchronization—Heart Failure (CARE-HF) Study Investigators.The Effect of Cardiac Resynchronization on Morbidity and Mortality in Heart Failure. N Engl J Me 2005;352(15):1539– 1549.
Bernheim A, Ammann P, Bernheim A, Ammann P, Sticherling C, Burger P, Schaer B, Brunner-La Rocca HP, Eckstein J, Kiencke S, Kaiser C, Linka A, Buser P, Pfisterer M, Osswald S. Right atrial pacing impairs cardiac function during resynchronization therapy:Acute effects of DDD pacing compared to VDD pacing. J Am Coll Cardiol 2005;45(9):1482–1487.
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. Circulation 1999;99:2993–3001.
Breithardt OA, Stellbrink C, Franke A, Balta O, Diem BH, Bakker P, Sack S, Auricchio A, Pochet T, Salo R, Pacing Therapies for Congestive Heart Failure Study Group; Guidant Congestive Heart Failure Research Group. Acute effects of cardiac resynchronization therapy on left ventricular Doppler indices in patients with congestive heart failure. Am Heart J 2002;143:34–44.
Nishimura RA, Hayes DL, Holmes DR, Tajik AJ. Mechanism of hemodynamic improvement by dual-chamber pacing for severe left ventricular dysfunction:an acute doppler and catheterization hemodynamic study. J Am Coll Cardiol 1995;25:281–288.
Auricchio A, Salo RW. Acute hemodynamic improvement by pacing in patients with severe congestive heart failure. Pacing Clin Electrophysiol 1997;20:313–324.
Inoue N, Ishikawa T, Sumita S, Nakagawa T, Kobayashi T, Matsushita K, Matsumoto K, Ohkusu Y, Taima M, Kosuge M, Uchino K, Kimura K, Umemura S. Long-Term Follow-Up of Atrioventricular Delay Optimization in Patients with Biventricular Pacing. Circ J 2005;69:201–204.
Lane RE, Chow AW, Chin D, Mayet J. Selection and Optimization of Biventricular Pacing:The Role of Echocardiography. Heart 2004;90(Suppl VI):10–16.
Vardas, P. Pacing Follow Up Techniques and Trouble Shooting During Biventricular Pacing. J Interven Card Electro 2003;9:183–187.
Ricci R, Ansalone G, Toscano SC, Pignalberi, Lunati M, Gasparini M, Padeletti L, Disertori M, Ravassi PA, Santini M on behalf of the InSync Italian Registry Investigators. Cardiac Resynchronization:Materials, Technique and results. The InSync Italian Registry. Eur Heart J Supp 2000;2(Suppl J):J6–J15.
Bhatta L, Luck J, Wolbrette D, Naccarelli G. Complications of biventricular pacing. Curr Opin Cardiol 2003;19:31–35.
Greenberg J, Mera F, DeLurgio D, et al. Safety of Implantation of Cardiac Resynchronization Devices:A Review of Major Biventricular Pacing Trials. Pacing Clin Electrophysiol 2003;26(4):952.
Leon AR. Cardiac Resynchronization Therapy Devices:Patient Management and Follow-Up Strategies. Rev Cardiovasc Med 2003;4(suppl2):S38–S46.
Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, Kutalek SP, Sharma A. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator:The Dual-chamber and Implantable Defibrillator (DAVID) trial. J Am Med Assoc 2002;288(24):3115–3123.
Leon AR. Practical issues in cardiac resynchronization therapy device implantation. Rev Cardiovasc Med 2003;4:142–149.
Knight B, Desai A, Coman J, Faddis M, Yong P. Long-term retention of cardiac resynchronization therapy. J Am Coll Cardiol 2004;44(1):72–77.
Higgins SL, Hummel JD, Niazi IK, Guidici MC, Worley SJ, Saxon LA, Boehner JP, Higginbotham MB, De Marco T, Foster E, Yong PG. Cardiac Resynchronization Therapy for the reatment of Heart Failure in Patients with Intraventricular Conduction Delay and Malignant Ventricular Tachyarrhythmias. J Am Coll Cardio 2003;42(8):1454–1459.
Kalinchak D, Schoenfeld M. Cardiac Resynchronization:A Brief Synopsis. PartII:Implant and Followup Methodology. J Interven Card Electro 2003;9:163–166.
Rho RW, Patel VV, Kokovic DZ, et al. Elevation in Ventricular Threshold with the use of the Y-Adaptor. Pacing Clin Electrophysiol 2003;26:747–751.
Kanagaratnam L, Pavia S, Schweikert R, Marrouche N, Lam C, Abreu M, Ching E, Chung M, Saliba W, Niebauer M, Wilkoff B, Tchou P, Natale A. Matching approved “nondedicated” hardware to obtain biventricular pacing and defibrillation:Feasibility and Troubleshooting. Pacing Clin Electrophysio 2002;25(7):1066–1071.
Pitzalis MV, Iacoviello M, Romito R, Guida P, De Tommasi E, Luzzi G, Anaclerio M, Forleo C, Rizzon P. Ventricular asynchrony predicts a better outcome in patients with chronic heart failure receiving cardiac resynchronization therapy. J Am Coll Cardio 2005;45(1):65–69.
Pitzalis MV, Iacoviello M, Romito R, Massari F, Rizzon B, Luzzi G, Guida P, Andriani A, Mastropasqua F, Rizzon P. Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony. J Am Coll Cardio 2002;40:1615–1622.
Cleland J, Daubert J, Erdmann E, Freemantle N, Gras D, Kappenberger L, Klein W, Tavazzi L, CARE-HF study Steering Committee and Investigators. The CARE-HF study (CArdiac REsynchronisation in Heart Failure study):rationale, design and end-points. Eur J Heart Fail 2001 Aug;3(4):481–489.
Rouleau F, Merheb M, Geffroy S, Berthelot J, Chaleil D, Dupuis JM, Victor J, Geslin P. Echocardiographic assessment of the interventricular delay of activation and correlation to the QRS width in dilated cardiomyopathy. Pacing Clin Electrophysio 2001;24(10):1500–1506.
Notabartolo D, Merlino JD, Smith AL, DeLurgio DB, Vera FV, Easley KA, Martin RP, Leon AR. Usefulness of the peak velocity difference by tissue Doppler imaging technique as an effective predictor of response to cardiac resynchronization therapy. Am J Cardiol 2004;94(6):817–820.
Penicka M, Bartunek J, De Bruyne B, Vanderheyden M, Goethals M, De Zutter M, Brugada P, Geelen P. Improvement of Left Ventricular Function After Cardiac Resynchronization Therapy is Predicted by Tissue Doppler Imaging Echocardiography.Circulation 2004;109:978–983.
Sogaard P, Egeblad H, Pedersen AK, Kim WY, Kristensen B, Hansen P, Mortensen P. Sequential versus Simultaneous Biventricular Resynchronization for Severe Heart Failure:Evaluation by Tissue Doppler Imagin. Circulation 2002;106:2078–2084.
Sogaard P, Egeblad H, Kim W, Jensen H, Pedersen A, Kristensen B, Mortensen P. Tissue Doppler Imaging Predicts Improved Systolic Performance and Reversed Left Ventricular Remodeling during Long-term Cardiac Resynchronization Therapy. J Am Coll Cardiol 2002;40:723–730.
Yu CM, Fung WH, Lin H, Zhang Q, Sanderson J, Lau C. Predictors of Left Ventricular Remodeling after Cardiac Resynchronization Therapy for Heart Failure Secondary to Idiopathic dilated or Ischemic Cardiomyoapthy. Am J Cardiol 2003;91:684–688.
Gorcsan J, Kanzaki H, Bazaz R, Dohi K, Schwartzman D. Usefulness of Echocardiographic Tissue Synchronization Imaging to Predict Acute Response to Cardiac Resynchronization Therapy. Am J Cardiol 2004;93:1178–1181.
Sun J, Chinchoy E, Donal E, Popovic Z, Perlic G, Asher C, Greenberg N, Grimm R, Wilkoff B, Thomas J. Evaluation of Ventricular Synchrony Using Novel Doppler Echocardiographic Indices in Patients with Heart Failure Receiving Cardiac Resynchronization Therapy.J Am Soc Echocardio 2004:845–850.
Breithardt O, Stellbrink C, Kramer A, Sinha A, Franke A, Salo R, Schiffgens B, Huvelle E, Auricchio A.PATH-CHF Study Group:Pacing Therapies for Congestive Heart Failure. Echocardiographic quantification of left ventricular asynchrony predicts an acute hemodynamic benefit of cardiac resynchronization therapy. Echocardiographic quantification of left ventricular asynchrony predicts an acute hemodynamic benefit of cardiac resynchronization therapy. J Am Coll Cardiol 2002;40(3):536–545.
Yu, Cheuk-Man, Abraham, William T., Bax, Jeroen, Chung, Eugene, Fedewa, Michelle, Ghio, Stefano, Leclercq, Christophe, Leon, Angel R., Merlino, John, Nihoyannopoulos, Petros, Notabartolo, Dean, Sun, Jing Ping, Tavazzi, Luigi. On behalf of the PROSPECT Investigators Predictors of response to cardiac resynchronization therapy (PROSPECT)-study design. American Heart Journal 2005;149(4):600–605.
Publication Committee for the VMAC Investigators Intravenous Nesiritide vs Nitroglycerin for Treatment of Decompensated Congestive Heart Failure:A Randomized Controlled Trial. J Am Med Assoc 2002;287(12):1531–1540.
Fonarow GC. The Acute Decompensated Heart Failure National Registry (ADHERE):Opportunities to Improve Care of Patients Hospitalized with Acute Decompensated Heart Failure. Rev Cardiovasc Med 2003;4(suppl 7):S21– S30.
Kindermann M, Frohlig G, Doerr T, Schieffer H. Optimizing the AV Delay in DDD pacemaker patients with high degreee AV block:mitral valve impedance cardiography. Pacing Clin Electrophysiol 1997;20:2453–2462.
Ritter PH, Dib JC, Lelievre T, et al. Quick determination of the optimal AV delay at rest in patients paced in DDD mode for complete AV block. Eur J CP 1994;4(2):39.
Knebel F, Reibis R, Bondke H, Witte J, Walde T, Eddicks S, Baumann G, Borges A. Tissue Doppler Echocardiography and Biventricular Pacing in Heart Failure:Patient Selection, Procedural Guidance, Follow-up, Quantification of Success. Cardiovasc Ultrasound 2004;2:17.
Perego GB, Chianca R, Facchini M, Frattola A, Balla E, Zucchi S, Cavaglia S, Vicini I, Negretto M, Osculati G. Simultaneous vs. sequential biventricular pacing in dilated cardiomyopathy:an acute hemodynamic study. Eur J Heart Fail 2003;5:305–313.
Mortensen Peter T, Sogaard Peter, Mansour Hassan, Ponsonaille Jean, Gras Daniel, Lazarus Arnaud, Reiser Wolfgang, Alonso Christine, Linde Cecilia M, Lunati Maurizio, Kramm Berthold, Harrison E. Mark. Sequential biventricular pacing:Evaluation of safety and efficacy.Pacing Clin Electrophysiol 2004;27(3):339–345.
Wilkoff B, Hess M, Young J, Abraham W. Differences in Tachyarrhythmia Detection and Implantable Cardioverter Defibrillator Therapy by Primary or Secondary Prevention Indication in Cardiac Resynchronization Therapy Patients.J Cardiovasc Electrophy 2004;15(9):1002–1009.
Bradley David J, Bradley Elizabeth A, Baughman Kenneth L, Berger Ronald D, Calkins Hugh, Goodman Steven N, Kass David A, Powe Neil R. Cardiac Resynchronization and Death From Progressive Heart Failure:A Meta-analysis of Randomized Controlled Trials.JAMA 2003;289(6):730–740.
Moss A, Zareba W, Hall W, Klein H, Wilber D, Cannom D, Daubert J, Higgins S, Brown M, Andrews M for the MulticenterAutomatic Defibrillator Implantation Trial II Investigators. Prophylactic Implantation of a Defibrillator in Patients with Myocardial Infarction and Reduced Ejection Fraction.N Engl J Med 2002;346:877–883.
Bardy G, Lee K, Mark D, Poole J, Packer D, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty S, Clapp-Channing N, Davidson-Ray L, Fraulo E, Fishbein D, Luceri R, Ip J, for the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an Implantable Cardioverter-Defibrillator for Congestive Heart Failure. New Eng J Med 2005;352(3):225–237.
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, the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure.New Eng J Med 2004;350:2140–2150.
Bocchiardo M, Achtelik M, Gaita F, Trappe HJ, Lozano I, Higgins S, Daovd E, Yong P, Duby C; VENTAK CHF/CONTAK CD Investigators. Efficacy of Biventricular Sensing and Treatment of Ventricualr Tachycardia.Pacing Clin Electrophysio 2000;23(III):1989–1991.
Ahmad A, Wang P, et al. Frequent ICD Shocks Due to Double Sensing in Patients with Biventricular Cardiovertor Defibrillators.J Interven Card Electrophysio 2003;9:377–381.
Garcia-Moran E, Mont L, Brugada J. Inappropriate tachycardia detection by a biventricular implantable cardiovertor defibrillator.Pacing Clin Electrophysio 2002;25:123–124.
Chugh A, Scharf C, Hall B, Cheung P, Good E, Horwood L, Oral H, Pelosi F Jr, Morady F. Prevalence and management of inappropriate detection and therapies in patients with first-generation biventricular pacemaker-defibrillators. Pacing Clin Electrophysio 2005;28(1):44–50.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Gassis, S., Le, A.R. Cardiac Resynchronization Therapy: Strategies for Device Programming, Troubleshooting and Follow-Up. J Interv Card Electrophysiol 13, 209–222 (2005). https://doi.org/10.1007/s10840-005-3247-9
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s10840-005-3247-9