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Cardiac resynchronization therapy

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Abstract

Despite advances in medical therapy for patients with congestive heart failure, morbidity and mortality remain high. Conventional atrioventricular pacing with a short atrioventricular delay was first introduced as a non-pharmacologic treatment for patients with severe heart failure. Further development of this new therapeutic approach led to biventricular pacing, also known as cardiac resynchronization therapy. Many studies have been published and many are still ongoing. This review summarizes the results reported in randomized trials and focuses on questions that have not yet been answered.

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References and Recommended Reading

  1. The CONSENSUS Trial Study Group: Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandanavian Enalapril Survival Study (CONSENSUS). N Engl J Med 1987, 316:1429–1435.

    Article  Google Scholar 

  2. Pitt B, Poole-Wilson PA, Segal R, et al.: Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomized trial: the Losartan Heart Failure Survival Study ELITE II. Lancet 2000,355:1582–1587.

    Article  PubMed  CAS  Google Scholar 

  3. Leizorovicz A, Lechat P, Cucherat M, et al.: Bisoprolol for the treatment of chronic heart failure: a meta-analysis on individual data of two placebo-controlled studies—CIBIS and CIBIS II. Cardiac Insufficiency Bisoprolol Study. Am Heart J 2002, 143:301–307.

    Article  PubMed  Google Scholar 

  4. Effect of metoprolol CR/XL in chronic heart failure. Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 1999, 353:2001–2007.

  5. Eichhorn EJ, Bristow MR: The Carvedilol Prospective Randomized Cumulative Survival (COPERNICUS) trial. Curr Control Trials Cardiovasc Med 2001, 2:20–23.

    Article  PubMed  CAS  Google Scholar 

  6. Pitt B, Zannad F, Remme WJ, et al.: The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med 1999, 341:709–717.

    Article  PubMed  CAS  Google Scholar 

  7. Advisory Council to Improve Outcomes Nationwide in Heart Failure: Consensus recommendations for the management of chronic heart failure [abstract]. Am J Cardiol 1999, 83(2A).

  8. Berry C, Murdoch DR, McMurray JJ: Economics of chronic heart failure. Eur J Heart Fail 2001, 3:283–291.

    Article  PubMed  CAS  Google Scholar 

  9. Cazeau S, Leclercq C, Lavergne T, et al.: Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Eng J Med 2001,344:873–880.

    Article  CAS  Google Scholar 

  10. Stellbrink C, Breithardt O, Franke A, et al.: 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, 38:1957–1965. This article is the first one to include and investigate the remodeling process that goes on under BV stimulation. The question of why some patients benefit more than others might be answered by focusing on the remodeling process.

    Article  PubMed  CAS  Google Scholar 

  11. Gras D, Mabo P, Tang T, et al.: Multisite pacing as a supplemental treatment of congestive heart failure: preliminary results of the Medtronic Inc. InSync Study. Pacing Clin Electrophysiol 1998, 21:2249–2255.

    Article  PubMed  CAS  Google Scholar 

  12. Nelson GS, Berger RD, Fetics BJ, et al.: Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block. Circulation 2000, 102:3053–3059. This article showed that CRT in a similar manner to inotropic drugs significantly increases ventricular systolic function, but differently from intropic drugs decreases cardiac oxygen consumption.

    PubMed  CAS  Google Scholar 

  13. Grines CL, Bashore TM, Boudoulas H, et al.: Functional abnormalities in isolated left bundle branch block. The effect of interventricular asynchrony. Circulation 1989, 79:845–853.

    PubMed  CAS  Google Scholar 

  14. Xiao HB, Brecker SJD, Gibson DG: Differing effects of right ventricular pacing and left bundle branch block on left ventricular function. Br Heart J 1993, 69:166–173.

    PubMed  CAS  Google Scholar 

  15. Aaronson KD, Schwartz JS, Chen TM, et al.: Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation 1997, 95:2660–2667.

    PubMed  CAS  Google Scholar 

  16. Xiao HB, Roy C, Gibson DG: Nature of ventricular activation in patients with dilated cardiomyopathy: evidence for bilateral bundle branch block. Br Heart J 1994, 72:167–174.

    PubMed  CAS  Google Scholar 

  17. Saxon LA, Kerwin WF, Cahalan MK, et al.: 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.

    Article  PubMed  CAS  Google Scholar 

  18. Freedman RA, Yock PG, Echt DS, et al.: Effect of variation in PQ interval on pattern of atrioventricular valve motion and flow in patients with normal ventricular function. J Am Coll Cardiol 1986, 7:595–602.

    Article  PubMed  CAS  Google Scholar 

  19. Ishikawa T, Sumita S, Kimura K, et al.: Critical PQ interval for the appearance of diastolic mitral regurgitation and optimal PQ interval in patients implanted with DDD pacemakers. PACE Pacing Clin Electrophysiol 1994, 17:1989–1994.

    Article  PubMed  CAS  Google Scholar 

  20. Auricchio A, Salo RW: Acute hemodynamic improvements by pacing in patients with severe congestive heart failure. Pacing Clin Electrophyisiol 1997, 20:313–324.

    Article  CAS  Google Scholar 

  21. Brecker SJD, Xiao HB, Sparrow J, et al.: Effects of dual-chamber pacing with short atrioventricular delay in dilated cardiomyopathy. Lancet 1992, 340:1308–1312.

    Article  PubMed  CAS  Google Scholar 

  22. Breithardt OE, Stellbrink C, Kramer A, et al.: Echocardiographic quantification of left ventricular asynchrony predicts acute benefits of cardiac resynchronization therapy in patients with heart failure and conduction delay. J Am Coll Cardiol 2002, in press

  23. Auricchio A, Ding J, Spinelli JC, et al., for the PATH-CHF Study Group: Cardiac resynchronization therapy restores optimal atrioventricular mechanical timing in heart failure patients with ventricular conduction delay. J Am Coll Cardiol 2002, 39:1163–1169.

    Article  PubMed  Google Scholar 

  24. Bortone AS, Hess OM, Chiddo A, et al.: Functional and structural abnormalities in patients with dilated cardiomyopathy. J Am Coll Cardiol 1989, 14:613–623.

    Article  PubMed  CAS  Google Scholar 

  25. Otsuji Y, Gilon D, Jiang L, et al.: Restricted diastolic opening of the mitral leafletes in patients with ventriular dysfuntion: evidence for increased valve tethering. J Am Coll Cardiol 1998, 32:398–404.

    Article  PubMed  CAS  Google Scholar 

  26. Ogawa S, Hubbard FE, Mardelli TJ, et al.: Cross-sectional echocardiographic spectrum of papillary muscle dysfunction. Am Heart J 1979, 97:312–321.

    Article  PubMed  CAS  Google Scholar 

  27. Blanc JJ, Etienne Y, Gilard M, et al.: Evaluation of different ventricular pacing sites in patients with severe heart failure. Results of an acute hemodynamic study. Circulation 1997, 96:3273–3277.

    PubMed  CAS  Google Scholar 

  28. Auricchio A, Stellbrink C, Block M, et al., on behalf of the PATH-CHF Study Investigators: The effect of pacing chamber and atrio-ventricular delay on acute systolic function of paced patients with congestive heart failure. Circulation 1999, 99:2993–3001.

    PubMed  CAS  Google Scholar 

  29. Kass DA, Chen CH, Curry C, et al.: Improved left ventricular mechanics form acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay. Circulation 1999, 99:1567–1573.

    PubMed  CAS  Google Scholar 

  30. Auricchio A, Stellbrink C, Sack S, et al., for the Pacing Therapies in Congestive Heart Failure Study Group: Chronic effect of hemodynamically optimized cardiac resynchronization therapy on patients with heart failure and ventricular conduction delay. J Am Coll Cardiol 2002, 39:2026–2033.

    Article  PubMed  Google Scholar 

  31. Leclercq C, Kass DA: Retiming the failing heart: principles and current clinical status of cardiac resynchronization. J Am Coll Cardiol 2002, 39:194–201. This article contains many details of cardiac resynchronization. Provides a good overview on the current status of CRT, and important developments and clinical trials.

    Article  PubMed  Google Scholar 

  32. Cazeau S, Leclercq C, Lavergne T, et al.: Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigators. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001, 344:873–880.

    Article  PubMed  CAS  Google Scholar 

  33. Abraham WT, Fisher WG, Smith A, et al.: Cardiac resynchronization in chronic heart failure. N Engl J Med 2002, 346:1845–1853.

    Article  PubMed  Google Scholar 

  34. Contak CD CRT-D Trial. FDA Website P 010012.

  35. Saxon LA, DeMarco T, Chatterjee K, et al., for the VIGOR-CHF Investigators: The magnitude of sympathoneural activation in advanced heart failure is altered with chronic biventricular pacing [abstract]. PACE Pacing Clin Electrophysiol 1998, 21:914.

    Google Scholar 

  36. Nelson GS, Curry CW, Wyman BT, et al.: Predictors of systolic augmentation from left ventricular preexcitation in patients with dilated cardiomyopathy and intraventricular conduction delay. Circulation 2000, 101:2703.

    PubMed  CAS  Google Scholar 

  37. Zhou Q, Henein M, Coats A, et al.: Different effects of abnormal activation and myocardial disease on left ventricular ejection and filling times. Heart 2000, 84:272–276.

    Article  PubMed  CAS  Google Scholar 

  38. Auricchio A, Kloss M, Trautmann SI, et al.: Exercise performance following cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. Am J Cardiol 2002, 89:198–203. This article deals with the development of CPX-metabolic and ventilation parameters under BV pacing. VO2 is measured, along with heart rate, ventilation, carbon dioxide production, and other metabolic measurements. The new approach attempts to show that patients with depressed metabolic and ventilation parameters and higher heart rate at baseline seem to benefit most from BV pacing.

    Article  PubMed  Google Scholar 

  39. Saxon LA, De Marco T, Schafer J, et al., for the VIGOR Congestive Heart Failure Investigators: Effects of long-term biventricular stimulation for resynchronization on echocardiographic measures of remodeling. Circulation 2002, 105:1304–1310.

    Article  PubMed  Google Scholar 

  40. Butter C, Auricchio A, Stellbrink C, et al., on behalf of the Pacing Therapy for Chronic Heart Failure II (PATH-CHF-II) Study Group: Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients. Circulation 2001, 104:3026–3029

    PubMed  CAS  Google Scholar 

  41. Auricchio A, Geller CJ, Reek S, et al.: Delayed electrical activation of the left septum and lateral wall in left bundle branch block: Insight from 3-D Electroanatomical Mapping [abstract]. J Am Coll Cardiol 2002, 39:96A.

    Article  Google Scholar 

  42. Yu Y, Auricchio A, Ding J, et al.: Identification of patients suitable for ventricular resynchronization therapy based on normalized LV-RV pressure loop area. Eur J Heart Fail 2000, 2:103–104.

    Google Scholar 

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Authors and Affiliations

  1. Division of Cardiology, University Hospital Magdeburg, Leipzigerstrae 44, D-39120, Magdeburg, Germany

    Silke Isabelle Trautmann MD, Michael Kloss MD & Angelo Auricchio MD, PhD

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  1. Silke Isabelle Trautmann MD
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  2. Michael Kloss MD
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  3. Angelo Auricchio MD, PhD
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Trautmann, S.I., Kloss, M. & Auricchio, A. Cardiac resynchronization therapy. Curr Cardiol Rep 4, 371–378 (2002). https://doi.org/10.1007/s11886-002-0036-2

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  • DOI: https://doi.org/10.1007/s11886-002-0036-2

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