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Cardiac Resynchronization Therapy

By L. Brent Mitchell, MD, Libin Cardiovascular Institute of Alberta

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Patient Education

The need for treatment of arrhythmias depends on the symptoms and the seriousness of the arrhythmia. Treatment is directed at causes. If necessary, direct antiarrhythmic therapy, including antiarrhythmic drugs, cardioversion-defibrillation, implantable cardioverter-defibrillators (ICDs), pacemakers (and a special form of pacing, cardiac resynchronization therapy), or a combination, is used.

In some patients, the normal, orderly, sequential relationship between contraction of the cardiac chambers is disrupted (becomes dyssynchronous). Dyssynchrony may be

  • Atrioventricular: Between atrial and ventricular contraction

  • Interventricular: Between left and right ventricular contraction

  • Intraventricular: Between different segments of left ventricular contraction

Patients at risk for dyssynchrony include those with the following:

  • Ischemic or nonischemic dilated cardiomyopathy

  • Prolonged QRS interval (≥ 130 msec)

  • Left ventricular end-diastolic dimension ≥ 55 mm

  • Left ventricular ejection fraction ≤ 35% in sinus rhythm

Cardiac resynchronization therapy (CRT) involves use of a pacing system to resynchronize cardiac contraction. Such systems usually include a right atrial lead, right ventricular lead, and left ventricular lead. Leads may be placed transvenously or surgically via thoracotomy. In heart failure patients with New York Heart Association (NYHA) class II, III, and IV symptoms, CRT can reduce hospitalization for heart failure and reduce all-cause mortality. However, there is little to no benefit in patients with permanent atrial fibrillation, right bundle branch block, nonspecific intraventricular conduction delay, or only mild prolongation of QRS duration (< 150 msec).

* This is the Professional Version. *