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STATE-OF-THE-ART PAPER

Management of Heart Failure After Cardiac Resynchronization Therapy

Integrating Advanced Heart Failure Treatment With Optimal Device Function

Juan M. Aranda, Jr, MD, FACC^_*,_*, Gregory W. Woo, MD^_*, Richard S. Schofield, MD, FACC^_*, Eileen M. Handberg, ARNP, PhD^_*, James A. Hill, MD, FACC^_*, Anne B. Curtis, MD, FACC^_*, Samuel F. Sears, PhD, J. Sean Goff, ARNP^_*, Daniel F. Pauly, MD, FACC^_* and Jamie B. Conti, MD, FACC^_*

^_* Division of Cardiovascular Medicine, College of Medicine, University of Florida Health Science Center, Gainesville, Florida
Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida Health Science Center, Gainesville, Florida.

Manuscript received December 22, 2004; revised manuscript received February 23, 2005, accepted March 10, 2005.

^_* Reprint requests and correspondence: Dr. Juan M. Aranda, Jr., 1600 SW Archer Road, Room M421, Gainesville, Florida 32610. (Email: arandjm{at}medicine.ufl.edu).

Cardiac resynchronization therapy (CRT) is an established adjunctive treatment for patients with systolic heart failure (HF) and ventricular dyssynchrony. The majority of recipients respond to CRT with improvements in quality of life, New York Heart Association functional class, 6-min walk test, and ventricular function. Management of HF after CRT may include up-titration of neurohormonal blockade and an exercise prescription through cardiac rehabilitation to further improve and sustain clinical outcomes. Diagnostic data provided by the CRT device may help to facilitate and optimize treatment. Initial nonresponder rates remain problematic. We suggest a simple step-by-step management and troubleshooting strategy that integrates device function with advanced HF therapy in patients who do not initially respond to CRT. This algorithm represents a new, comprehensive, collaborative approach between the HF and electrophysiology specialists to further improve and sustain outcomes in the field of CRT.

Abbreviations and Acronyms   AV = atrioventricular   CRT = cardiac resynchronization therapy   HF = heart failure   LV = left ventricular   NYHA = New York Heart Association   VV = interventricular

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