STATE-OF-THE-ART PAPER
Cardiac Resynchronization Therapy
Part 2—Issues During and After Device Implantation and Unresolved Questions
Jeroen J. Bax, MD*,*,
Theodore Abraham, MD, FACC ,
S. Serge Barold, MD, FACC ,
Ole A. Breithardt, MD ,
Jeffrey W.H. Fung, MD||,
Stephane Garrigue, MD, PhD¶,
John Gorcsan, III, MD, FACC#,
David L. Hayes, MD, FACC**,
David A. Kass, MD,
Juhani Knuuti, MD, PhD,
Christophe Leclercq, MD, PhD,
Cecilia Linde, MD, PhD,
Daniel B. Mark, MD, PhD, FACC||||,
Mark J. Monaghan, PhD¶¶,
Petros Nihoyannopoulos, MD, FRCP, FACC, FESC***,
Martin J. Schalij, MD*,
Christophe Stellbrink, MD and
Cheuk-Man Yu, MD||
* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Johns Hopkins University, Baltimore, Maryland
University of South Florida, Tampa, Florida
University Klinikum Mannheim, Mannheim, Germany
|| The Chinese University of Hong Kong, Hong Kong, China
¶ Hopital cardiologique du Haut-Leveque, Pessac, France
# University of Pittsburgh, Pittsburgh, Pennsylvania
** Mayo Clinic, Rochester, Minnesota
Turku PET Center, University of Turku, Turku, Finland
Hopital Pontchaillou, Rennes, France
Karolinska University Hospital, Stockholm, Sweden
|||| Duke Clinical Research Institute, Durham, North Carolina
¶¶ King’s College Hospital, London, United Kingdom
*** Hammersmith Hospital, London, United Kingdom
Stadtische Kliniken Bielefeld, Bielefeld, Germany
Manuscript received May 2, 2005;
revised manuscript received September 19, 2005,
accepted September 19, 2005.
* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. (Email: jbax{at}knoware.nl).
Encouraged by the clinical success of cardiac resynchronization therapy (CRT), the implantation rate has increased exponentially, although several limitations and unresolved issues of CRT have been identified. This review concerns issues that are encountered during implantation of CRT devices, including the role of electroanatomical mapping, whether CRT implantation should be accompanied by simultaneous atrioventricular nodal ablation in patients with atrial fibrillation, procedural complications, and when to consider surgical left ventricular lead positioning. Furthermore, (echocardiographic) CRT optimization and assessment of CRT benefits after implantation are highlighted. Also, controversial issues such as the potential value of CRT in patients with mild heart failure or narrow QRS complex are addressed. Finally, open questions concerning when to combine CRT with implantable cardioverter-defibrillator therapy and the cost-effectiveness of CRT are discussed.
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Abbreviations and Acronyms
| | AF = atrial fibrillation | | AV = atrioventricular | | COMPANION = Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure | | CRT = cardiac resynchronization therapy | | ICD = implantable cardioverter-defibrillator | | LBBB = left bundle branch block | | LV = left ventricle/ventricular | | LVEF = left ventricular ejection fraction | | MR = mitral regurgitation | | MUSTIC = Multisite Simulation in Cardiomyopathies trial | | NYHA = New York Heart Association | | PET = positron emission tomography | | QALY = quality adjusted life year | | RV = right ventricle/ventricular | | TDI = tissue Doppler imaging | | VV = interventricular |
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J. J. Bax
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