![]() ![]() Pacing modalities that utilize biventricular (BiV) or left ventricular (LV) stimulation to optimize cardiac pump function through synchronization of ventricular contraction are referred to as resynchronization or ventricular resynchronization therapies. Īccordingly, the idea that cardiac-pacing technology might be used to restore the synchrony of ventricular contraction has been of theoretical interest for over a decade. The finding of IVCD has been associated with clinical instability and an increased risk of death in patients with heart failure. Specifically, dyssynchronous contraction exacerbates inefficient use of energy by the heart (a process termed mechanoenergetic-uncoupling ). ![]() This dyssynchronous pattern of ventricular contraction is believed to contribute to the pathophysiology of heart failure, reducing the already diminished contractile reserve of the heart. Our aim in this descriptive review is to define practice guidelines and to improve clinicians' knowledge of the available published clinical evidence, concentrating on few randomized controlled trials.Īpproximately 30 percent of patients with cardiomyopathy have IVCD such as left or right bundle-branch block, leading to loss of coordination of ventricular contraction. Recent studies have also focused on the combined use of CRT and implantable cardioverter defibrillator (ICD) and it has shown encouraging results. It has also been shown to benefit drug refractory angina in CHF. Recently benefits of CRT have also been observed in CHF patients who do not have wide QRS complexes on electrocardiogram (EKG). It has improved exercise tolerance and NYHA functional class in such patients in sinus rhythm and a recent meta-analysis has also shown mortality benefits in CHF. ![]() Cardiac resynchronization therapy (CRT) is a new modality that involves synchronization of ventricular contraction and has shown a lot of promise in managing symptomatic patients of CHF who are on optimal medical therapy and have interventricular conduction delay (IVCD). Despite these therapeutic advances, it is generally accepted that current therapies do not adequately address the clinical need of patients with heart failure, and additional strategies are being developed. Mechanical support with left ventricular assist devices and heart transplantation are reserved for the minority of patients who have severely decompensated heart failure. Newer non-pharmacological therapies for heart failure are being evaluated for patients of congestive heart failure (CHF). ![]()
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