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Congestive Heart Failure and Cardiac Transplantation pp 341–359Cite as

Advanced Therapies: Cardiac Resynchronization Therapy for Heart Failure

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Abstract

Cardiac resynchronization therapy (CRT) refers to the application of multisite ventricular pacing with the goal of normalizing left and right ventricular timing (i.e., resynchronizing) that has been disturbed by heart disease. Current CRT methods are imperfect, but they do represent a major advance in managing systolic heart failure (HF). As an “advanced” therapy, CRT offers the advantages of both being widely available (as opposed to, e.g., ventricular assist devices or heart transplantation) and having abundant data supporting its clinical utility (as opposed to, e.g., the current state of stem cell therapy). Further, to the extent that CRT improves inotropy, it is unique in that, unlike pharmacologic inotropic agents such as dobutamine [1] or milrinone [2], it does not increase—and may decrease—mortality.

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Abbreviations

6 MW:

6-minute walk

ACCF:

American College of Cardiology Foundation

AF:

Atrial fibrillation

AHA:

American Heart Association

AV:

Atrioventricular

CRT:

Cardiac resynchronization therapy

CRT-D:

Cardiac resynchronization therapy-defibrillator

CRT-P:

Cardiac resynchronization therapy-pacemaker

CS:

Coronary sinus

ESC:

European Society of Cardiology

HF:

Heart failure

HFSA:

Heart Failure Society of America

HQ:

High quality (evidence)

HR:

Hazard ratio

HRS:

Heart Rhythm Society

ICD:

Implantable cardioverter defibrillator

IVCD:

Intraventricular conduction delay

LA:

Left atrium, left atrial

LBBB:

Left bundle branch block

LoE:

Level of evidence

LQ:

Low quality (evidence)

LV:

Left ventricle, left ventricular

LVEF:

Left ventricular ejection fraction

LVESVI:

Left ventricular end-systolic volume index

m:

meters

MRI:

Magnetic resonance imaging

ms:

Milliseconds

NYHA:

New York Heart Association

OPT:

Optimal pharmacologic heart failure therapy

Q-LV interval:

Time from QRS onset on surface ECG to local activation on left ventricular (or coronary sinus) lead

QOL:

Quality of life

QRSd:

QRS duration

RA:

Right atrium, right atrial

RBBB:

Right bundle branch block

RV:

Right ventricle, right ventricular

SoR:

Strength of recommendation

VO2 :

Oxygen consumption

VT:

Ventricular tachycardia

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  1. Medicine/Cardiology, University of Minnesota Fairview Medical Center, 420 Delaware Street SE, MMC 508, Minneapolis, MN, 55455, USA

    Scott Sakaguchi MD, Henri Roukoz MD & David G. Benditt MD

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  1. Scott Sakaguchi MD
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  2. Henri Roukoz MD
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  3. David G. Benditt MD
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  1. Lillehei Heart Institute, Department of Medicine, University of Minnesota Medical Center, University of Minnesota, Minneapolis, Minnesota, USA

    Daniel J. Garry

  2. Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA

    Robert F. Wilson

  3. Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, Minnesota, USA

    Zeev Vlodaver

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Sakaguchi, S., Roukoz, H., Benditt, D.G. (2017). Advanced Therapies: Cardiac Resynchronization Therapy for Heart Failure. In: Garry, D., Wilson, R., Vlodaver, Z. (eds) Congestive Heart Failure and Cardiac Transplantation. Springer, Cham. https://doi.org/10.1007/978-3-319-44577-9_21

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