Skip to main content
SpringerLink
Log in
Book cover

Handbook of Cardiac Anatomy, Physiology, and Devices pp 475–497Cite as

Cardiac Resynchronization Therapy

  • Chapter
  • First Online:

  • 5140 Accesses

Abstract

Congestive heart failure (CHF) has become a major health problem. Despite improved pharmacologic therapies, refractory symptoms and high mortality remain a challenge in such patients. There has been increased interest in the application of ancillary nonpharmacologic therapies for CHF management, such as implantable pacemakers, defibrillators, and/or left ventricular assist devices. Various methods of cardiac pacing are discussed and contrasted in this chapter, with the focus on biventricular pacing and cardiac resynchronization therapy for treatment of CHF. Cardiac resynchronization therapy has now become a part of standard therapy for patients with severe symptomatic CHF and intraventricular dyssynchrony.

This is a preview of subscription content, log in via an institution.

References

  1. Hunt SA, Baker DW, Chin MH, et al. ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: Executive summary. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure): Developed in Collaboration With the International Society for Heart and Lung Transplantation; Endorsed by the Heart Failure Society of America. Circulation 2001;104:2996–3007.

    Article  PubMed  CAS  Google Scholar 

  2. Fei L, Wrobleski D, Groh W, Vetter A, Duffin EG, Zipes DP. Effects of multisite ventricular pacing on cardiac function in normal dogs and dogs with heart failure. J Cardiovasc Electrophysiol 1999;10:935–46.

    Article  PubMed  CAS  Google Scholar 

  3. Wilkoff BL, Cook JR, Epstein AE, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: Te Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 2002;288:3115–23.

    Article  PubMed  Google Scholar 

  4. Bernstein AD, Daubert JC, Fletcher RD, et al. The revised NASPE/BPEG generic code for antibradycardia, adaptive-rate, and multisite pacing. North American Society of Pacing and Electrophysiology/British Pacing and Electrophysiology Group. PACE 2002;25:260–64.

    Article  PubMed  Google Scholar 

  5. Leclercq C, Gras D, Le Helloco A, Nicol L, Mabo P, Daubert C. Hemodynamic importance of preserving the normal sequence of ventricular activation in permanent cardiac pacing. Am Heart J 1995;129:1133–41.

    Article  PubMed  CAS  Google Scholar 

  6. de Cock CC, Vos DH, Jessurun E, Allaart CP, Visser CA. Effects of stimulation site on diastolic function in cardiac resynchronization therapy. Pacing Clin Electrophysiol 2007;30:S40–42.

    PubMed  Google Scholar 

  7. Yu CM, Zhang Q, Yip GW, et al. Are left ventricular diastolic function and diastolic asynchrony important determinants of response to cardiac resynchronization therapy? Am J Cardiol 2006;98:1083–87.

    Article  PubMed  Google Scholar 

  8. Cazeau S, Leclercq C, Lavergne T, et al. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001;344:873–80.

    Article  PubMed  CAS  Google Scholar 

  9. Linde C, Leclercq C, Rex S, et al. Long-term benefits of biventricular pacing in congestive heart failure: results from the MUltisite STimulation in cardiomyopathy (MUSTIC) study. J Am Coll Cardiol 2002;40:111–18.

    Article  PubMed  Google Scholar 

  10. Gras D, Mabo P, Tang T, et al. Multisite pacing as a supplemental treatment of congestive heart failure: preliminary results of the Medtronic Inc. InSync Study. PACE 1998;21:2249–55.

    Article  CAS  Google Scholar 

  11. Gras D, Leclercq C, Tang AS, Bucknall C, Luttikhuis HO, Kirstein-Pedersen A. Cardiac resynchronization therapy in advanced heart failure the multicenter InSync clinical study. Eur J Heart Fail 2002;4:311–20.

    Article  PubMed  Google Scholar 

  12. Abraham WT, Fisher WG, Smith AL, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med 2002;346:1845–53.

    Article  PubMed  Google Scholar 

  13. Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002;346:877–83.

    Article  PubMed  Google Scholar 

  14. Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005;352:225–37.

    Article  PubMed  CAS  Google Scholar 

  15. Young JB, Abraham WT, Smith AL, et al. Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: The MIRACLE ICD Trial. JAMA 2003;289:2685–94.

    Article  PubMed  Google Scholar 

  16. CRM GC. Summary of safety and effectiveness CONTAK-CD system.

    Google Scholar 

  17. Bristow MR, Saxon LA, Boehmer J, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004;350:2140–50.

    Article  PubMed  CAS  Google Scholar 

  18. Cleland JG, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005;352:1539–49.

    Article  PubMed  CAS  Google Scholar 

  19. Cleland JG, Daubert JC, Erdmann E, et al. Longer-term effects of cardiac resynchronization therapy on mortality in heart failure [the CArdiac REsynchronization-Heart Failure (CARE-HF) trial extension phase]. Eur Heart J 2006;27:1928–32.

    Article  PubMed  Google Scholar 

  20. Lau CP, Yu CM, Chau E, et al. Reversal of left ventricular remodeling by synchronous biventricular pacing in heart failure. PACE 2000;23:1722–25.

    PubMed  CAS  Google Scholar 

  21. Baller D, Wolpers HG, Zipfel J, Hoeft A, Hellige G. Unfavorable effects of ventricular pacing on myocardial energetics. Basic Res Cardiol 1981;76:115–23.

    Article  PubMed  CAS  Google Scholar 

  22. Nelson GS, Berger RD, Fetics BJ, et al. Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block. Circulation 2000;102:3053–59.

    PubMed  CAS  Google Scholar 

  23. Ukkonen H, Beanlands RS, Burwash IG, et al. Effect of cardiac resynchronization on myocardial efficiency and regional oxidative metabolism. Circulation 2003;107:28–31.

    Article  PubMed  CAS  Google Scholar 

  24. Flevari P, Theodorakis G, Paraskevaidis I, et al. Coronary and peripheral blood flow changes following biventricular pacing and their relation to heart failure improvement. Europace 2006;8:44–50.

    Article  PubMed  Google Scholar 

  25. Vanderheyden M, Mullens W, Delrue L, et al. Myocardial gene expression in heart failure patients treated with cardiac resynchronization therapy responders versus nonresponders. J Am Coll Cardiol 2008;51:129–36.

    Article  PubMed  CAS  Google Scholar 

  26. Ypenburg C, van Erven L, Bleeker GB, et al. Benefit of combined resynchronization and defibrillator therapy in heart failure patients with and without ventricular arrhythmias. J Am Coll Cardiol 2006;48:464–70.

    Article  PubMed  Google Scholar 

  27. Chalil S, Yousef ZR, Muyhaldeen SA, et al. Pacing-induced increase in QT dispersion predicts sudden cardiac death following cardiac resynchronization therapy. J Am Coll Cardiol 2006;47:2486–92.

    Article  PubMed  Google Scholar 

  28. Harada M, Osaka T, Yokoyama E, Takemoto Y, Ito A, Kodama I. Biventricular pacing has an advantage over left ventricular epicardial pacing alone to minimize proarrhythmic perturbation of repolarization. J Cardiovasc Electrophysiol 2006;17:151–56.

    Article  PubMed  Google Scholar 

  29. Germano JJ, Reynolds M, Essebag V, Josephson ME. Frequency and causes of implantable cardioverter-defibrillator therapies: is device therapy proarrhythmic? Am J Cardiol 2006;97:1255–61.

    Article  PubMed  Google Scholar 

  30. Gottipaty VK, Krelis SP, Fei L, et al. Patients with congestive heart failure and permanent pacemaker have an increased risk of “non-sudden” death. J Am Coll Cardiol 1999;33:125A.

    Article  Google Scholar 

  31. Auricchio A, Metra M, Gasparini M, et al. Long-term survival of patients with heart failure and ventricular conduction delay treated with cardiac resynchronization therapy. Am J Cardiol 2007;99:232–38.

    Article  PubMed  Google Scholar 

  32. Bradley DJ, Bradley EA, Baughman KL, et al. Cardiac resynchronization and death from progressive heart failure: a meta-analysis of randomized controlled trials. JAMA 2003;289:730–40.

    Article  PubMed  Google Scholar 

  33. Salukhe TV, Dimopoulos K, Francis D. Cardiac resynchronisation may reduce all-cause mortality: meta-analysis of preliminary COMPANION data with CONTAK-CD, InSync ICD, MIRACLE and MUSTIC. Int J Cardiol 2004;93:101–03.

    Article  PubMed  Google Scholar 

  34. Rivero-Ayerza M, Theuns DA, Garcia-Garcia HM, Boersma E, Simoons M, Jordaens LJ. Effects of cardiac resynchronization therapy on overall mortality and mode of death: A meta-analysis of randomized controlled trials. Eur Heart J 2006;27:2682–88.

    Article  PubMed  Google Scholar 

  35. Gasparini M, Lunati M, Santini M, et al. Long-term survival in patients treated with cardiac resynchronization therapy: A 3-year follow-up study from the InSync/InSync ICD Italian Registry. Pacing Clin Electrophysiol 2006;29:S2–10.

    Article  PubMed  Google Scholar 

  36. Delnoy PP, Ottervanger JP, Luttikhuis HO, et al. Sustained benefit of cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2007;18:298–302.

    Article  PubMed  Google Scholar 

  37. Dilaveris P, Pantazis A, Giannopoulos G, Synetos A, Gialafos J, Stefanadis C. Upgrade to biventricular pacing in patients with pacing-induced heart failure: can resynchronization do the trick? Europace 2006;8:352–57.

    Article  PubMed  Google Scholar 

  38. Doshi RN, Daoud EG, Fellows C, et al. Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study). J Cardiovasc Electrophysiol 2005;16:1160–65.

    Article  PubMed  Google Scholar 

  39. Gasparini M, Auricchio A, Regoli F, et al. Four-year efficacy of cardiac resynchronization therapy on exercise tolerance and disease progression: The importance of performing atrioventricular junction ablation in patients with atrial fibrillation. J Am Coll Cardiol 2006;48:734–43.

    Article  PubMed  Google Scholar 

  40. Lu F, Iaizzo PA, Benditt DG, Mehra R, Warman EN, McHenry BT. Isolated atrial segment pacing: an alternative to his bundle pacing after atrioventricular junctional ablation. J Am Coll Cardiol 2007;49:1443–49.

    Article  PubMed  Google Scholar 

  41. Yu CM, Chan YS, Zhang Q, et al. Benefits of cardiac resynchronization therapy for heart failure patients with narrow QRS complexes and coexisting systolic asynchrony by echocardiography. J Am Coll Cardiol 2006;48:2251–57.

    Article  PubMed  Google Scholar 

  42. Beshai JF, Grimm RA, Nagueh SF, et al. Cardiac-resynchronization therapy in heart failure with narrow QRS complexes. N Engl J Med 2007;357:2461–71.

    Article  PubMed  CAS  Google Scholar 

  43. Blanc JJ, Etienne Y, Gilard M, et al. Evaluation of different ventricular pacing sites in patients with severe heart failure: Results of an acute hemodynamic study. Circulation 1997;96:3273–77.

    PubMed  CAS  Google Scholar 

  44. Butter C, Auricchio A, Stellbrink C, et al. Should stimulation site be tailored in the individual heart failure patient? Am J Cardiol 2000;86:K144–51.

    Article  Google Scholar 

  45. Alonso C, Leclercq C, Victor F, et al. Electrocardiographic predictive factors of long-term clinical improvement with multisite biventricular pacing in advanced heart failure. Am J Cardiol 1999;84:1417–21.

    Article  PubMed  CAS  Google Scholar 

  46. Auricchio A, Stellbrink C, Sack S, et al. The Pacing Therapies for Congestive Heart Failure (PATH-CHF) study: Rationale, design, and endpoints of a prospective randomized multicenter study. Am J Cardiol 1999;83:130D–35D.

    Article  PubMed  CAS  Google Scholar 

  47. Auricchio A, Klein H, Tockman B, et al. Transvenous biventricular pacing for heart failure: Can the obstacles be overcome? Am J Cardiol 1999;83:136D–42D.

    Article  PubMed  CAS  Google Scholar 

  48. Rossillo A, Verma A, Saad EB, et al. Impact of coronary sinus lead position on biventricular pacing: mortality and echocardiographic evaluation during long-term follow-up. J Cardiovasc Electrophysiol 2004;15:1120–25.

    Article  PubMed  Google Scholar 

  49. Perego GB, Chianca R, Facchini M, et al. Simultaneous vs. sequential biventricular pacing in dilated cardiomyopathy: An acute hemodynamic study. Eur J Heart Fail 2003;5:305–13.

    Article  PubMed  Google Scholar 

  50. Mortensen PT, Sogaard P, Mansour H, et al. Sequential biventricular pacing: Evaluation of safety and efficacy. Pacing Clin Electrophysiol 2004;27:339–45.

    Article  PubMed  Google Scholar 

  51. Leon AR, Abraham WT, Brozena S, et al. Cardiac resynchronization with sequential biventricular pacing for the treatment of moderate-to-severe heart failure. J Am Coll Cardiol 2005;46:2298–304.

    Article  PubMed  Google Scholar 

  52. Buckingham TA, Candinas R, Schlapfer J, et al. Acute hemodynamic effects of atrioventricular pacing at differing sites in the right ventricle individually and simultaneously. PACE 1997;20:909–15.

    Article  PubMed  CAS  Google Scholar 

  53. Ortega DF, Pellegrino GM, Barja LD, Albina G, Laino R, Giniger A. Biventricular pacing using two pacemakers and the triggered VVT mode. Pacing Clin Electrophysiol 2002;25:1534–35.

    PubMed  Google Scholar 

  54. Lu F, Miller LW. Biventricular pacing for congestive heart failure. In: Iaizzo PA, ed. Cardiac anatomy, physiology and devices: A handbook for the biomedical engineer, 1st ed. Totowa, NJ: The Humana Press Inc., 2005:812–22.

    Google Scholar 

  55. Gras D, Bocker D, Lunati M, et al. Implantation of cardiac resynchronization therapy systems in the CARE-HF trial: Procedural success rate and safety. Europace 2007;9:516–22.

    Article  PubMed  CAS  Google Scholar 

  56. Leon AR, Abraham WT, Curtis AB, et al. Safety of transvenous cardiac resynchronization system implantation in patients with chronic heart failure: combined results of over 2,000 patients from a multicenter study program. J Am Coll Cardiol 2005;46:2348–56.

    Article  PubMed  Google Scholar 

  57. Reynolds MR, Cohen DJ, Kugelmass AD, et al. The frequency and incremental cost of major complications among medicare beneficiaries receiving implantable cardioverter-defibrillators. J Am Coll Cardiol 2006;47:2493–97.

    Article  PubMed  Google Scholar 

  58. Ammann P, Sticherling C, Kalusche D, et al. An electrocardiogram-based algorithm to detect loss of left ventricular capture during cardiac resynchronization therapy. Ann Intern Med 2005;142:968–73.

    PubMed  Google Scholar 

  59. Abraham WT. Cardiac resynchronization therapy for heart failure: Biventricular pacing and beyond. Curr Opin Cardiol 2002;17:346–52.

    Article  PubMed  Google Scholar 

  60. Richardson M, Freemantle N, Calvert MJ, Cleland JG, Tavazzi L. Predictors and treatment response with cardiac resynchronization therapy in patients with heart failure characterized by dyssynchrony: A pre-defined analysis from the CARE-HF trial. Eur Heart J 2007;28:1827–34.

    Article  PubMed  Google Scholar 

  61. Lellouche N, De Diego C, Cesario DA, et al. Usefulness of preimplantation B-type natriuretic peptide level for predicting response to cardiac resynchronization therapy. Am J Cardiol 2007;99:242–46.

    Article  PubMed  CAS  Google Scholar 

  62. Sutton MG, Plappert T, Hilpisch KE, Abraham WT, Hayes DL, Chinchoy E. Sustained reverse left ventricular structural remodeling with cardiac resynchronization at one year is a function of etiology: Quantitative Doppler echocardiographic evidence from the Multicenter InSync Randomized Clinical Evaluation (MIRACLE). Circulation 2006;113:266–72.

    Article  PubMed  Google Scholar 

  63. Garrigue S, Reuter S, Labeque JN, et al. Usefulness of biventricular pacing in patients with congestive heart failure and right bundle branch block. Am J Cardiol 2001;88:1436–41, A8.

    Article  PubMed  CAS  Google Scholar 

  64. Byrne MJ, Helm RH, Daya S, et al. Diminished left ventricular dyssynchrony and impact of resynchronization in failing hearts with right versus left bundle branch block. J Am Coll Cardiol 2007;50:1484–90.

    Article  PubMed  Google Scholar 

  65. Leclercq C, Faris O, Tunin R, et al. Systolic improvement and mechanical resynchronization does not require electrical synchrony in the dilated failing heart with left bundle-branch block. Circulation 2002;106:1760–63.

    Article  PubMed  Google Scholar 

  66. Auricchio A, Stellbrink C, Butter C, et al. Clinical efficacy of cardiac resynchronization therapy using left ventricular pacing in heart failure patients stratified by severity of ventricular conduction delay. J Am Coll Cardiol 2003;42:2109–16.

    Article  PubMed  Google Scholar 

  67. Bleeker GB, Holman ER, Steendijk P, et al. Cardiac resynchronization therapy in patients with a narrow QRS complex. J Am Coll Cardiol 2006;48:2243–50.

    Article  PubMed  Google Scholar 

  68. Steendijk P, Tulner SA, Bax JJ, et al. Hemodynamic effects of long-term cardiac resynchronization therapy: Analysis by pressure-volume loops. Circulation 2006;113:1295–304.

    Article  PubMed  Google Scholar 

  69. Bleeker GB, Mollema SA, Holman ER, et al. Left ventricular resynchronization is mandatory for response to cardiac resynchronization therapy: Analysis in patients with echocardiographic evidence of left ventricular dyssynchrony at baseline. Circulation 2007;116:1440–48.

    Article  PubMed  Google Scholar 

  70. Butter C, Auricchio A, Stellbrink C, et al. Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients. Circulation 2001;104:3026–29.

    Article  PubMed  CAS  Google Scholar 

  71. Toussaint JF, Lavergne T, Kerrou K, et al. Basal asynchrony and resynchronization with biventricular pacing predict long-term improvement of LV function in heart failure patients. Pacing Clin Electrophysiol 2003;26:1815–23.

    Article  PubMed  Google Scholar 

  72. Suffoletto MS, Dohi K, Cannesson M, Saba S, Gorcsan J III. Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation 2006;113:960–68.

    Article  PubMed  Google Scholar 

  73. Lambiase PD, Rinaldi A, Hauck J, et al. Non-contact left ventricular endocardial mapping in cardiac resynchronisation therapy. Heart 2004;90:44–51.

    Article  PubMed  CAS  Google Scholar 

  74. Tse HF, Lee KL, Wan SH, et al. Area of left ventricular regional conduction delay and preserved myocardium predict responses to cardiac resynchronization therapy. J Cardiovasc Electrophysiol 2005;16:690–95.

    Article  PubMed  Google Scholar 

  75. Helm RH, Byrne M, Helm PA, et al. Three-dimensional mapping of optimal left ventricular pacing site for cardiac resynchronization. Circulation 2007;115:953–61.

    Article  PubMed  Google Scholar 

  76. Bernheim A, Ammann P, Sticherling C, et al. Right atrial pacing impairs cardiac function during resynchronization therapy: Acute effects of DDD pacing compared to VDD pacing. J Am Coll Cardiol 2005;45:1482–87.

    Article  PubMed  Google Scholar 

  77. Calvert MJ, Freemantle N, Yao G, et al. Cost-effectiveness of cardiac resynchronization therapy: Results from the CARE-HF trial. Eur Heart J 2005;26:2681–88.

    Article  PubMed  Google Scholar 

  78. Ward A, Guo S, Caro JJ. Cost-effectiveness of cardiac resynchronization therapy. J Am Coll Cardiol 2006;48:1283.

    Article  PubMed  Google Scholar 

  79. Bentkover JD, Dorian P, Thibault B, Gardner M. Economic analysis of a randomized trial of biventricular pacing in Canada. Pacing Clin Electrophysiol 2007;30:38–43.

    Article  PubMed  Google Scholar 

  80. Van de Veire NR, Schuijf JD, De Sutter J, et al. Non-invasive visualization of the cardiac venous system in coronary artery disease patients using 64-slice computed tomography. J Am Coll Cardiol 2006;48:1832–38.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Minnesota, Department of Medicine, MMC 508, 420 Delaware St. SE, Minneapolis, MN, 55455, USA

    Fei Lü

Authors
  1. Fei Lü
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fei Lü .

Editor information

Editors and Affiliations

  1. Dept. Surgery, University of Minnesota, Delaware St. SE., 420, Minneapolis, 55455, U.S.A.

    Paul A. Iaizzo

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Humana Press, a part of Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Lü, F. (2009). Cardiac Resynchronization Therapy. In: Iaizzo, P. (eds) Handbook of Cardiac Anatomy, Physiology, and Devices. Humana Press. https://doi.org/10.1007/978-1-60327-372-5_28

Download citation

  • DOI: https://doi.org/10.1007/978-1-60327-372-5_28

  • Published:

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-60327-371-8

  • Online ISBN: 978-1-60327-372-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation