Cardiac resynchronization therapy indications
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Bhaskar Purushottam, M.D. [2], Hardik Patel, M.D.
Overview
Cardiac resynchronization therapy (CRT) with or without an ICD is indicated in patients who have an LVEF less than or equal to 35%, a QRS duration greater than or equal to 0.15 seconds, and normal sinus rhythm, for the treatment of NYHA functional Class III or ambulatory Class IV heart failure symptoms in patients whose medical therapy has been optimized.
Indications
2012 ACCF/AHA/HRS Focused Update of the 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities (DO NOT EDIT)[1]
CRT in Patients With Systolic Heart Failure (DO NOT EDIT)[1]
| Class I |
| "1. CRT is indicated for patients who have LVEF less than or equal to 35%, sinus rhythm, LBBB with a QRS duration greater than or equal to 150 ms, and NYHA class II, III, or ambulatory IV symptoms on GDMT. (Level of Evidence: A for NYHA class III/IV[2][3][4][5]; Level of Evidence: B for NYHA class II[6][7])" |
| Class III (No Benefit) |
| "1. CRT is not recommended for patients with NYHA class I or II symptoms and non-LBBB pattern with QRS duration less than 150 ms.[6][7][8] (Level of Evidence: B)" |
| "2. CRT is not indicated for patients whose comorbidities and/or frailty limit survival with good functional capacity to less than 1 year.[5] (Level of Evidence: C)" |
| Class IIa |
| "1. CRT can be useful for patients who have LVEF less than or equal to 35%, sinus rhythm, LBBB with a QRS duration 120 to 149 ms, and NYHA class II, III, or ambulatory IV symptoms on GDMT.[2][3][4][6][7][9] (Level of Evidence: B)" |
| "2. CRT can be useful for patients who have LVEF less than or equal to 35%, sinus rhythm, a non-LBBB pattern with a QRS duration greater than or equal to 150 ms, and NYHA class III/ambulatory class IV symptoms on GDMT.[2][3][4][7] (Level of Evidence: A)" |
| "3. CRT can be useful in patients with atrial fibrillation and LVEF less than or equal to 35% on GDMT if a) the patient requires ventricular pacing or otherwise meets CRT criteria and b) AV nodal ablation or pharmacologic rate control will allow near 100% ventricular pacing with CRT.[10][11][12][13][14][15] (Level of Evidence: B)" |
| "4. CRT can be useful for patients on GDMT who have LVEF less than or equal to 35% and are undergoing new or replacement device placement with anticipated requirement for significant (>40%) ventricular pacing.[12][16][17][18] (Level of Evidence: C)" |
| Class IIb |
| "1. CRT may be considered for patients who have LVEF less than or equal to 30%, ischemic etiology of heart failure, sinus rhythm, LBBB with a QRS duration of greater than or equal to 150 ms, and NYHA class I symptoms on GDMT.[6][7] (Level of Evidence: C)" |
| "2. CRT may be considered for patients who have LVEF less than or equal to 35%, sinus rhythm, a non-LBBB pattern with QRS duration 120 to 149 ms, and NYHA class III/ambulatory class IV on GDMT.[7][8] (Level of Evidence: B)" |
| "3. CRT may be considered for patients who have LVEF less than or equal to 35%, sinus rhythm, a non-LBBB pattern with a QRS duration greater than or equal to 150 ms, and NYHA class II symptoms on GDMT.[6][7] (Level of Evidence: B)" |
References
- ↑ 1.0 1.1 Tracy CM, Epstein AE, Darbar D, Dimarco JP, Dunbar SB, Estes NA, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD (2012). "2012 ACCF/AHA/HRS Focused Update of the 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Heart Rhythm. 9 (10): 1737–53. doi:10.1016/j.hrthm.2012.08.021. PMID 22975672. Retrieved 2012-11-01. Unknown parameter
|month=ignored (help) - ↑ 2.0 2.1 2.2 Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E; et al. (2002). "Cardiac resynchronization in chronic heart failure". N Engl J Med. 346 (24): 1845–53. doi:10.1056/NEJMoa013168. PMID 12063368. Review in: ACP J Club. 2002 Nov-Dec;137(3):82
- ↑ 3.0 3.1 3.2 Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T; et al. (2004). "Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure". N Engl J Med. 350 (21): 2140–50. doi:10.1056/NEJMoa032423. PMID 15152059. Review in: ACP J Club. 2004 Nov-Dec;141(3):60
- ↑ 4.0 4.1 4.2 Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L; et al. (2005). "The effect of cardiac resynchronization on morbidity and mortality in heart failure". N Engl J Med. 352 (15): 1539–49. doi:10.1056/NEJMoa050496. PMID 15753115. Review in: ACP J Club. 2005 Sep-Oct;143(2):29
- ↑ 5.0 5.1 Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG; et al. (2009). "2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation". J Am Coll Cardiol. 53 (15): e1–e90. doi:10.1016/j.jacc.2008.11.013. PMID 19358937.
- ↑ 6.0 6.1 6.2 6.3 6.4 Kozłowski B (2009). "[Commentary to the article: Moss AJ, Hall WJ, Cannom DS, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 2009; 361: 1329-38]". Kardiol Pol. 67 (12): 1417–8. PMID 20178156.
- ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S; et al. (2010). "Cardiac-resynchronization therapy for mild-to-moderate heart failure". N Engl J Med. 363 (25): 2385–95. doi:10.1056/NEJMoa1009540. PMID 21073365. Review in: Evid Based Med. 2011 Oct;16(5):138-9
- ↑ 8.0 8.1 Rickard J, Bassiouny M, Cronin EM, Martin DO, Varma N, Niebauer MJ; et al. (2011). "Predictors of response to cardiac resynchronization therapy in patients with a non-left bundle branch block morphology". Am J Cardiol. 108 (11): 1576–80. doi:10.1016/j.amjcard.2011.07.017. PMID 21890086.
- ↑ Linde C, Abraham WT, Gold MR, St John Sutton M, Ghio S, Daubert C; et al. (2008). "Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms". J Am Coll Cardiol. 52 (23): 1834–43. doi:10.1016/j.jacc.2008.08.027. PMID 19038680.
- ↑ Brignole M, Gammage M, Puggioni E, Alboni P, Raviele A, Sutton R; et al. (2005). "Comparative assessment of right, left, and biventricular pacing in patients with permanent atrial fibrillation". Eur Heart J. 26 (7): 712–22. doi:10.1093/eurheartj/ehi069. PMID 15618036.
- ↑ Brignole M, Botto G, Mont L, Iacopino S, De Marchi G, Oddone D; et al. (2011). "Cardiac resynchronization therapy in patients undergoing atrioventricular junction ablation for permanent atrial fibrillation: a randomized trial". Eur Heart J. 32 (19): 2420–9. doi:10.1093/eurheartj/ehr162. PMID 21606084.
- ↑ 12.0 12.1 Doshi RN, Daoud EG, Fellows C, Turk K, Duran A, Hamdan MH; et al. (2005). "Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study)". J Cardiovasc Electrophysiol. 16 (11): 1160–5. doi:10.1111/j.1540-8167.2005.50062.x. PMID 16302897.
- ↑ Gasparini M, Auricchio A, Regoli F, Fantoni C, Kawabata M, Galimberti P; et al. (2006). "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. 48 (4): 734–43. doi:10.1016/j.jacc.2006.03.056. PMID 16904542.
- ↑ Wilton SB, Leung AA, Ghali WA, Faris P, Exner DV (2011). "Outcomes of cardiac resynchronization therapy in patients with versus those without atrial fibrillation: a systematic review and meta-analysis". Heart Rhythm. 8 (7): 1088–94. doi:10.1016/j.hrthm.2011.02.014. PMID 21338711.
- ↑ Upadhyay GA, Choudhry NK, Auricchio A, Ruskin J, Singh JP (2008). "Cardiac resynchronization in patients with atrial fibrillation: a meta-analysis of prospective cohort studies". J Am Coll Cardiol. 52 (15): 1239–46. doi:10.1016/j.jacc.2008.06.043. PMID 18926327.
- ↑ Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H; et al. (2002). "Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial". JAMA. 288 (24): 3115–23. PMID 12495391.
- ↑ Adelstein E, Schwartzman D, Gorcsan J, Saba S (2011). "Predicting hyperresponse among pacemaker-dependent nonischemic cardiomyopathy patients upgraded to cardiac resynchronization". J Cardiovasc Electrophysiol. 22 (8): 905–11. doi:10.1111/j.1540-8167.2011.02018.x. PMID 21332868.
- ↑ Vatankulu MA, Goktekin O, Kaya MG, Ayhan S, Kucukdurmaz Z, Sutton R; et al. (2009). "Effect of long-term resynchronization therapy on left ventricular remodeling in pacemaker patients upgraded to biventricular devices". Am J Cardiol. 103 (9): 1280–4. doi:10.1016/j.amjcard.2009.01.023. PMID 19406272.