Four-Year Efficacy of Cardiac Resynchronization Therapy on Exercise Tolerance and Disease Progression

Gasparini, Maurizio; Auricchio, Angelo; Regoli, François; Fantoni, Cecilia; Kawabata, Mihoko; Galimberti, Paola; Pini, Daniela; Ceriotti, Carlo; Gronda, Edoardo; Klersy, Catherine; Fratini, Simona; Klein, Hermann H.

doi:10.1016/j.jacc.2006.03.056

Cited by 335 publications

(56 citation statements)

References 36 publications

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“…3 A sub-analysis of the CARE-HF trial showed that in patients with new onset of AF, CRT significantly improved patient outcomes compared with optimal medical therapy. 47 Interestingly, Gasparini et al 48 showed that in patients with permanent AF, the benefit observed with CRT was similar to that observed in sinus rhythm only in the sub-group of AF patients who underwent an atrio-ventricular node ablation and in whom biventricular pacing was applied at least 85% of time. Further large clinical trials specifically dedicated to this population are certainly warranted.…”

Section: Patients With Permanent Atrial Fibrillationmentioning

confidence: 83%

Cardiac resynchronization therapy: clinical results and evolution of candidate selection

Leclercq¹,

Bleeker²,

Linde³

et al. 2007

European Heart Journal Supplements

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Cardiac resynchronization therapy (CRT) is now a recommended treatment in patients with severe heart failure, a poor left ventricular (LV) ejection fraction and wide QRS of .120 ms. The implementation of CRT in the current guidelines for the treatment of chronic heart failure occurred after the results of different clinical trials including more than 4000 patients, especially the COMPANION and CARE-HF trials. These trials showed that CRT over and above optimal drug treatment improves symptoms, quality of life, exercise tolerance, but more importantly reduces mortality and morbidity. Another major finding was that CRT reverses LV remodelling, a major prognostic factor in heart failure. However, the rate of responders remains only 65-70%. So far, the only validated criterion of cardiac dyssynchrony is the QRS width on the surface ECG, which is probably not optimal. Echocardiographic techniques have shown interesting perspectives for optimizing patient selection, but still have to be validated. Moreover, new indications for CRT (patients with atrial fibrillation, narrow QRS, or mild heart failure) will probably be validated in the near future. The recent and future technical developments in the device will help to optimize the therapy and also to improve heart failure monitoring using sensors in the device and home monitoring by telephone or Internet.

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Section: Patients With Permanent Atrial Fibrillationmentioning

confidence: 83%

Cardiac resynchronization therapy: clinical results and evolution of candidate selection

Leclercq¹,

Bleeker²,

Linde³

et al. 2007

European Heart Journal Supplements

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show abstract

“…A recent prospective investigation that evaluated the role of atrioventricular junction ablation in patients with CRT devices and permanent atrial fibrillation demonstrated the potential benefit of this intervention. There were a significantly higher proportion of responders in the ablation group compared to those treated with CRT alone (68% vs. 18%) at 12 months [52]. Though AV nodal ablation is irreversible and usually causes dependence on proper pacemaker function for survival, such data support its consideration when atrial fibrillation is a limiting factor in the potential benefits a patient could derive from a CRT device.…”

Section: Consideration For Patients With Atrial Fibrillationmentioning

confidence: 85%

Strategies for pacemaker programming in acute heart failure

2011

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In the past decade, cardiac pacing devices (either permanent pacemakers or Implanted Cardioverter Defibrillators) have become increasingly common in patients with heart failure. The manner in which the device is programmed to pace the heart can have significant implications on cardiac hemodynamics, both positive and negative. As such, in patients hospitalized with acute heart failure who have cardiac pacing devices, the clinician should note whether the programming of the device could be contributing to the patient's symptoms, and whether further programming changes could be made to improve the patient's clinical status. As of this date, there are no consensus guidelines available for the management of pacemaker programming in acute heart failure. This review article will discuss the physiologic implications of several parameters of pacemaker programming on heart failure, including the degree of RV pacing, the programmed atrioventricular (AV) interval, and the programmed interventricular pacing delay in patients with cardiac resynchronization therapy (CRT) devices. Based on the available data on the above parameters, this article will then propose a general algorithmic approach to the evaluation and management of patients with pacing devices who are hospitalized with acute heart failure.

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“…In summary, a lower mean heart rate is associated with better clinical and hemodynamic response to CRT. In atrial fibrillation patients, one study suggests that beneficial effects are more pronounced after AV node ablation [13].…”

Section: Original Articlementioning

confidence: 99%

Cardiac rehabilitation in patients with pacemakers and implantable cardioverter defibrillators

Iliou

Blanchard

Lamar-Tanguy

et al. 2016

Monaldi Arch Chest Dis

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<p>Large subsets of patients admitted in cardiac rehabilitation centers are having a pacemaker, cardiac resynchronization (CRT) or implantable cardiac defibrillator (ICD). Cardiac rehabilitation for patients, mostly with heart failure, with implanted electronic devices as pacemakers or ICD is a unique opportunity not only to optimize the medical treatment, to increase their exercise capacity and improves their clinical condition but also to supervise the correct functioning of the device. CRT reduces clinical symptoms and increases slightly the exercise capacity. But in these patients, the clinical improvements are likely to be explained by both the enhancement of cardiac function induced by the device and by the improved peripheral (muscular and vascular) and cardiac effects of exercise. The additional expected gain by exercise in this population is between 14 to 25%. In patients implanted with an ICD, exercise training is safe, without increasing shocks or anti-tachycardia pacing therapy. The comprehensive cardiac rehabilitation combining exercise training and a psycho-educational intervention improves exercise capacity, quality of life, general and mental health. Nevertheless, further large scale studies was needed to evaluate the most appropriate management and demonstrate definitively the role of cardiac rehabilitation in this particular group of patients.</p>

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Four-Year Efficacy of Cardiac Resynchronization Therapy on Exercise Tolerance and Disease Progression

Abstract: Heart failure patients with ventricular conduction disturbance and permanent AF treated with CRT showed large and sustained long-term (up to 4 year) improvements of left ventricular function and functional capacity, similar to patients in SR, only if AVJ ablation was performed.

Cited by 335 publications

References 36 publications

Cardiac resynchronization therapy: clinical results and evolution of candidate selection

Cardiac resynchronization therapy: clinical results and evolution of candidate selection

Strategies for pacemaker programming in acute heart failure

Cardiac rehabilitation in patients with pacemakers and implantable cardioverter defibrillators

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