Avoiding non-responders to cardiac resynchronization therapy: a practical guide.

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 J

journal_title

European heart journal

authors

Daubert C,Behar N,Martins RP,Mabo P,Leclercq C

doi

10.1093/eurheartj/ehw270

subject

Has Abstract

pub_date

2017-05-14 00:00:00

pages

1463-1472

issue

19

eissn

0195-668X

issn

1522-9645

pii

ehw270

journal_volume

38

pub_type

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