Abstract:
:Over two decades after the introduction of cardiac resynchronization therapy (CRT) into clinical practice, ∼30% of candidates continue to fail to respond to this highly effective treatment of drug-refractory heart failure (HF). Since the causes of this non-response (NR) are multifactorial, it will require multidisciplinary efforts to overcome. Progress has, thus far, been slowed by several factors, ranging from a lack of consensus regarding the definition of NR and technological limitations to the delivery of therapy. We critically review the various endpoints that have been used in landmark clinical trials of CRT, and the variability in response rates that has been observed as a result of these different investigational designs, different sample populations enrolled and different means of therapy delivered, including new means of multisite and left ventricular endocardial simulation. Precise recommendations are offered regarding the optimal device programming, use of telemonitoring and optimization of management of HF. Potentially reversible causes of NR to CRT are reviewed, with emphasis on loss of biventricular stimulation due to competing arrhythmias. The prevention of NR to CRT is essential to improve the overall performance of this treatment and lower its risk-benefit ratio. These objectives require collaborative efforts by the HF team, the electrophysiologists and the cardiac imaging experts.
journal_name
Eur Heart Jjournal_title
European heart journalauthors
Daubert C,Behar N,Martins RP,Mabo P,Leclercq Cdoi
10.1093/eurheartj/ehw270subject
Has Abstractpub_date
2017-05-14 00:00:00pages
1463-1472issue
19eissn
0195-668Xissn
1522-9645pii
ehw270journal_volume
38pub_type
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journal_title:European heart journal
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pub_type: 杂志文章
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pub_type: 临床试验,杂志文章,随机对照试验
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journal_title:European heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
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