Cardiac Resynchronization Therapy for Mild Heart Failure

Reynolds, Carl; Gold, Michael R.

doi:10.1161/circulationaha.110.959056

Cited by 9 publications

(3 citation statements)

References 41 publications

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“…Our study evaluated a typical population of HF patients We non-invasively measured CO at rest and at peak exercise using IGR method. [23,24]. Differently, peak VO 2 , which is the gold standard of exercise performance evaluation, has been reported to increase after CRT only in patients with severely reduced exercise performance (10) , and specifically in subjects with a peak VO 2 <12 ml/kg/min [9,11], suggesting inconsistency between NYHA class improvement and peak VO 2 changes.…”

Section: Discussionmentioning

confidence: 99%

Is the Correct Anatomical Placement of the Electrocardiogram (ECG) Electrodes Essential to Diagnosis in the Clinical Setting: A Systematic Review

Hadjiantoni¹,

Oak²,

Mengi³

et al. 2021

Cardiol Cardiovasc Med

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Section: Discussionmentioning

confidence: 99%

Is the Correct Anatomical Placement of the Electrocardiogram (ECG) Electrodes Essential to Diagnosis in the Clinical Setting: A Systematic Review

Hadjiantoni¹,

Oak²,

Mengi³

et al. 2021

Cardiol Cardiovasc Med

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“…The indications for devices are becoming based on the earlier identification of serious disease and earlier intervention to decrease or eliminate progression of disease and the development of HF or a malignant ventricular tachyarrhythmia 6,22–25 . Decreased systolic function, or decreased LVEF or cardiomyopathy, may become the primary target for device therapy regardless of symptoms.…”

Section: Should Symptoms and The Severity Of Hf Still Dominate The Inmentioning

confidence: 99%

Evaluation of Heart Failure Symptoms for Device Therapy

Guglin

Barold

2012

Pacing Clinical Electrophis

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“…There is almost no evidence that the reduction of sudden death with an ICD depends on severity of congestion or NYHA class. About 30% of deaths in patients with dilated cardiomyopathy are sudden [40,41], and the severity of LV dysfunction-not the severity of symptoms-remains the best predictor of sudden cardiac death in this population. In this respect, the Sudden Cardiac Death in Heart Failure Trial conducted in class II and III HF patients with LVEF ≤35% showed improved mortality in class II NYHA patients but no survival benefit in NYHA class III patients [42].…”

Section: Indications For a Stand Alone Icdmentioning

confidence: 99%

Electrical devices for left ventricular dysfunction and heart failure: do we need revised guidelines?

Guglin

Barold

2011

J Interv Card Electrophysiol

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Three recent trials have demonstrated the benefit of cardiac resynchronization therapy (CRT) in the New York Heart Association (NYHA) class II patients with heart failure (HF) with ischemic or nonischemic cardiomyopathy as well as in NYHA class I (asymptomatic) patients mostly with ischemic cardiomyopathy. Earlier intervention with CRT in asymptomatic or minimally symptomatic patients improves survival and reduces HF hospitalizations. The reduction or the prevention of HF hospitalizations is of paramount importance because the HF episodes seem to alter the natural history of disease and are associated with deterioration of left ventricular (LV) function and a marked increase in mortality. The CRT benefit is greatest in patients with a QRS ≥ 150 ms. At this time, it would seem prudent to consider CRT-D (D = ICD) therapy for class I NYHA patients with a QRS ≥ 150 ms and an LV ejection fraction ≤ 30% regardless of etiology. Although the data for NYHA class I patients with nonischemic cardiomyopathy are scanty, the recommendation for class I patients is justified because CRT achieves a much greater degree of LV reverse remodeling in nonischemic compared to ischemic patients. With regard to lone ICDs, there is no evidence that they prevent sudden cardiac death more efficiently in symptomatic than in asymptomatic patients. Cardiomyopathy should be the primary target for device therapy regardless of symptoms for both CRT and lone ICD therapy. New guidelines are needed to address the role of CRT in hospitalized NYHA class IV HF patients or those who depend on inotropic therapy or an LV assist device because randomized CRT trials have not included these patients. CRT in these patients remains controversial. The mortality of such patients even with CRT is very high despite the occasional positive response. The role of CRT in patients waiting for cardiac transplantation also needs guidelines. With the expansion of CRT indications to minimally symptomatic or asymptomatic patients, the benefit of device therapy must be carefully weighed against the potential risk of lifelong device complications.

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Cardiac Resynchronization Therapy for Mild Heart Failure

Cited by 9 publications

References 41 publications

Is the Correct Anatomical Placement of the Electrocardiogram (ECG) Electrodes Essential to Diagnosis in the Clinical Setting: A Systematic Review

Is the Correct Anatomical Placement of the Electrocardiogram (ECG) Electrodes Essential to Diagnosis in the Clinical Setting: A Systematic Review

Evaluation of Heart Failure Symptoms for Device Therapy

Electrical devices for left ventricular dysfunction and heart failure: do we need revised guidelines?

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