Cardiac Resynchronization Therapy: An Established Pacing Therapy for Heart Failure and Mechanical Dyssynchrony

Scientific Evidences Supporting the Benefits of Cardiac Resynchronization Therapy: History of Cardiac Resynchronization Therapy

Author(s): Antonio Hernandez Madrid, Roberto Matia Frances and Concepcion Moro

Pp: 11-23 (13)

DOI: 10.2174/978160805030711101010011

* (Excluding Mailing and Handling)

Abstract

The idea of cardiac resynchronization therapy (CRT), most likely came out of a variety of animal studies performed in the late 1980s and early 1990s. From 1995 - 1997 there were many observational studies that confirmed the initial value of cardiac resynchronization. From 1998 - 1999 we had available randomized studies, placebo controlled, to determine exercise capacity, NYHA, quality of life, and from 2000 we had randomized studies to determine hospitalizations and mortality.

All randomized trials have confirmed a significant alleviation of symptoms and increase in exercise capacity: mean NYHA class decreased by 0.5-0.8 points, distance in 6 min walk test increased by a mean of 20% and peak oxygen consumption during exercise increased by 10-15%. Later, a meta analysis in 2003 found a 30% reduction of hospitalizations for the management of congestive heart failure (CHF), attributable to CRT. Lately, the study COMPANION: CRT with/out implantable cardiac defibrillator (ICD) lowered the combined end point of mortality and re-hospitalization by 35-40% and in the CARE-HF, CRT lowered the proportion of hospitalization for CHF by 52% and unplanned hospitalizations for major cardiovascular events by 39%. CRT reverses left ventricular (LV) remodelling, decreases LV end systolic and end diastolic volumes (By 15%), and increases LV ejection fraction (EF) (By 6%). The REVERSE study has confirmed this aspect. It is often said that about onethird of patients who appear to warrant CRT will not benefit from the therapy. The definition of failure to respond, however, needs to be considered carefully. The failure to implant an effectively functioning system, a poor lead position or failure of pacing stimuli may explain some non responders. Patients whose condition worsened with CRT might have done much worse without CRT, or worsen due to intercurrent illness. In summary there is a large number of patients studied in randomized clinical trials that demonstrate that CRT improves quality of life, exercise capacity, functional capacity, improves cardiac function and structure and, in addition, CRT reduces the risk of mortality.


Keywords: Cardiac resynchronization therapy, heart failure, multisite ventricular pacing, clinical trials

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      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Trial Access" as access_base_text, CASE j.type WHEN 111 THEN true ELSE false END as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_trail` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59274385 and j.to_ip >=59274385 )) and ((j.from_date <= 1739834606 and j.to_date >= 1739834606 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 1532) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Subscribed" as access_base_text, false as terms_popup, "S" as content_download_type, null as restricted_user_access_key, null as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_corporate` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59274385 and j.to_ip >=59274385 )) and ((j.from_date <= 1739834606 and j.to_date >= 1739834606 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 1532) union (select j.user_access_id,j.volume_id,j.user_id,j.from_ip,j.to_ip,j.type,j.track,"Token Based Access" as access_base_text, false as terms_popup, "R" as content_download_type, j.uc_id as restricted_user_access_key, "v" as restricted_user_access_type, CASE j.track WHEN 0 THEN false ELSE true END as tracksAccessByVolume,"chapter" as access_level, j.chapter_id from `user_access_chapter_token` as `j` inner join `user_access_info` as `info` on `j`.`user_access_id` = `info`.`user_access_id` where ((j.from_ip <= 59274385 and j.to_ip >=59274385 )) and ((j.from_date <= 1739834606 and j.to_date >= 1739834606 and j.perpetual= 0) or (j.from_date is null and j.to_date is null and j.perpetual= 1)) and j.chapter_id = 1532)
      550μsalphaeurekaselec_live_10_06_2022UserAccess.php#1266
      Backtrace
      • 13. app/Models/UserAccess/UserAccess.php:1266
      • 14. app/Http/Controllers/ChapterController.php:1549
      • 15. vendor/laravel/framework/src/Illuminate/Routing/Controller.php:54
      • 16. vendor/laravel/framework/src/Illuminate/Routing/ControllerDispatcher.php:43
      • 17. vendor/laravel/framework/src/Illuminate/Routing/Route.php:260
    • select b.banner_link, b.banner_name, b.banner_script, b.banner_remarks, b.banner_file_name, b.banner_placement, bd.content_type, bd.content_id from `tbl_banner` as `b` inner join `tbl_banner_detail` as `bd` on `bd`.`banner_id` = `b`.`banner_id` inner join `users` as `u` on `u`.`id` = `b`.`updated_by` where `b`.`banner_ebook` = 1 and `bd`.`content_type` = 'B' and `bd`.`content_id` = 901 and `b`.`banner_from_date` <= 1739834607 and `b`.`banner_to_date` >= 1739834607 and `b`.`banner_status` = 'A' order by `b`.`banner_id` desc
      1.09msalphaeurekaselec_live_10_06_2022Banner.php#95
      Bindings
      • 0: 1
      • 1: B
      • 2: 901
      • 3: 1739834607
      • 4: 1739834607
      • 5: A
      Backtrace
      • 13. app/Models/Banner.php:95
      • 14. app/Http/helpers.php:404
      • 17. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 18. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    • select count(*) as aggregate from `uc_cart_products` where cart_id='6c08db69cbb0c5220d6c51c61cbfa1a2'
      230μsalphaeurekaselec_live_10_06_2022Cart.php#271
      Backtrace
      • 15. app/Models/Cart.php:271
      • 16. view::layouts._header:260
      • 18. vendor/laravel/framework/src/Illuminate/Filesystem/Filesystem.php:124
      • 19. vendor/laravel/framework/src/Illuminate/View/Engines/PhpEngine.php:58
      • 20. vendor/laravel/framework/src/Illuminate/View/Engines/CompilerEngine.php:73
    App\Models\Keywords
    4Keywords.php#?
    App\Models\Chapter
    1Chapter.php#?
    App\Models\Ebook
    1Ebook.php#?
        _token
        xh5Vo84toljSuPrlP1fs1WiuG93kyaQfC70Bn5ZQ
        uc_cart_id
        6c08db69cbb0c5220d6c51c61cbfa1a2
        _previous
        array:1 [ "url" => "https://alpha.eurekaselect.com/chapter/1532" ]
        _flash
        array:2 [ "old" => [] "new" => [] ]
        PHPDEBUGBAR_STACK_DATA
        []
        path_info
        /chapter/1532
        status_code
        200
        
        status_text
        OK
        format
        html
        content_type
        text/html; charset=UTF-8
        request_query
        []
        
        request_request
        []
        
        request_headers
        0 of 0
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        request_cookies
        0 of 0
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        response_headers
        0 of 0
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        ClearShow all
        Date ↕MethodURLData
        #12025-02-17 23:23:27GET/chapter/1532112196