We have located links that may give you full text access.
ENGLISH ABSTRACT
JOURNAL ARTICLE
REVIEW
[Heart re-synchronization with biventricular stimulation: new treatment for refractory heart failure].
Despite continuous progress in drug therapy, many patients are still progressing into advanced heart failure, a very poor condition in terms of quality of life and prognosis. Therapeutic resources are quite limited at that end-stage. Heart transplantation may only be proposed to a small minority of patients. New non-pharmacological alternatives like cellular cardiomyo-plasty or left ventricular (LV) implantable assist device are still under evaluation. So simpler and cheaper approaches have imperatively to be developed for treating this highly invalidated and rapidly growing and ageing population. Cardiac resynchronization therapy (CRT) with multisite biventricular pacing has been initiated in France in early 90's. The aim of CRT is to try and correct the electromechanical abnormalities that result from antrioventricular and intraventricular conduction delay (IVCD), a very common observation (30-50%) in patients with chronic heart failure (CHF). IVCD worsens progressively overtime and is responsible for discoordinated interventricular and left-intraventricular contraction-relaxation which in turn enhances the hemodynamic consequences of the baseline LV systolic dysfunction. This new therapeutic concept was first assessed in acute hemodynamic studies with temporary pacing, then in pilot studies with permanent transvenous biventricular pacing. Several controlled studies (MUSTIC, MIRACLE, CONTAKCD...) were conducted afterwards and demonstrated that CRT might improve significantly symptoms, quality of life and exercise tolerance in patients with severe heart failure (NYHA class III -- IV) under optimized drug treatment, low ejection fraction and significant IVCD as indicated by an intrinsic QRS duration QRS> 150 MS. The rehospitalization rate was also significantly reduced with CRT. The clinical benefit was preserved over at least 1 year follow-up. The first validation stem is now completed. There are however several important questions yet to be answered. Which is the impact of CRT on all-cause mortality and sudden cardiac death? Two large-scale studies, CARE-HF in Europe and COMPANION in USA, are ongoing to try and answer this question. Which type of implantable devices has to be developed preferentially: multisite pacemakers or multisite pacemaker-defibrillators? May CRT induce LV reverse remodelling and thus help at preventing heart failure progression? Which cost-effectiveness ratio for heart faulure management? How to better select potential responders?... The whole validation process of CRT should be completed on 2004-2005.
Full text links
Related Resources
Trending Papers
Heart failure with preserved ejection fraction: diagnosis, risk assessment, and treatment.Clinical Research in Cardiology : Official Journal of the German Cardiac Society 2024 April 12
Proximal versus distal diuretics in congestive heart failure.Nephrology, Dialysis, Transplantation 2024 Februrary 30
World Health Organization and International Consensus Classification of eosinophilic disorders: 2024 update on diagnosis, risk stratification, and management.American Journal of Hematology 2024 March 30
Efficacy and safety of pharmacotherapy in chronic insomnia: A review of clinical guidelines and case reports.Mental Health Clinician 2023 October
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app