PMID- 22173864
OWN - NLM
STAT- MEDLINE
DCOM- 20121212
LR  - 20211021
IS  - 1572-8595 (Electronic)
IS  - 1383-875X (Linking)
VI  - 34
IP  - 2
DP  - 2012 Aug
TI  - Electrical devices for left ventricular dysfunction and heart failure: do we need 
      revised guidelines?
PG  - 197-204
LID - 10.1007/s10840-011-9639-0 [doi]
AB  - Three recent trials have demonstrated the benefit of cardiac resynchronization 
      therapy (CRT) in the New York Heart Association (NYHA) class II patients with 
      heart failure (HF) with ischemic or nonischemic cardiomyopathy as well as in NYHA 
      class I (asymptomatic) patients mostly with ischemic cardiomyopathy. Earlier 
      intervention with CRT in asymptomatic or minimally symptomatic patients improves 
      survival and reduces HF hospitalizations. The reduction or the prevention of HF 
      hospitalizations is of paramount importance because the HF episodes seem to alter 
      the natural history of disease and are associated with deterioration of left 
      ventricular (LV) function and a marked increase in mortality. The CRT benefit is 
      greatest in patients with a QRS >/= 150 ms. At this time, it would seem prudent to 
      consider CRT-D (D = ICD) therapy for class I NYHA patients with a QRS >/= 150 ms 
      and an LV ejection fraction </= 30% regardless of etiology. Although the data for 
      NYHA class I patients with nonischemic cardiomyopathy are scanty, the 
      recommendation for class I patients is justified because CRT achieves a much 
      greater degree of LV reverse remodeling in nonischemic compared to ischemic 
      patients. With regard to lone ICDs, there is no evidence that they prevent sudden 
      cardiac death more efficiently in symptomatic than in asymptomatic patients. 
      Cardiomyopathy should be the primary target for device therapy regardless of 
      symptoms for both CRT and lone ICD therapy. New guidelines are needed to address 
      the role of CRT in hospitalized NYHA class IV HF patients or those who depend on 
      inotropic therapy or an LV assist device because randomized CRT trials have not 
      included these patients. CRT in these patients remains controversial. The 
      mortality of such patients even with CRT is very high despite the occasional 
      positive response. The role of CRT in patients waiting for cardiac 
      transplantation also needs guidelines. With the expansion of CRT indications to 
      minimally symptomatic or asymptomatic patients, the benefit of device therapy 
      must be carefully weighed against the potential risk of lifelong device 
      complications.
FAU - Guglin, Maya
AU  - Guglin M
AD  - Department of Cardiology, University of South Florida, 2 Tampa General Circle, 
      Suite 5074, Tampa, FL 33618, USA. mguglin@gmail.com
FAU - Barold, S Serge
AU  - Barold SS
LA  - eng
PT  - Journal Article
DEP - 20111217
PL  - Netherlands
TA  - J Interv Card Electrophysiol
JT  - Journal of interventional cardiac electrophysiology : an international journal of 
      arrhythmias and pacing
JID - 9708966
SB  - IM
MH  - Cardiac Resynchronization Therapy/*standards/*statistics & numerical data
MH  - Evidence-Based Medicine
MH  - Heart Failure/*epidemiology/*prevention & control
MH  - Humans
MH  - *Practice Guidelines as Topic
MH  - Prevalence
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/*epidemiology/*prevention & control
EDAT- 2011/12/17 06:00
MHDA- 2012/12/13 06:00
CRDT- 2011/12/17 06:00
PHST- 2011/09/04 00:00 [received]
PHST- 2011/10/28 00:00 [accepted]
PHST- 2011/12/17 06:00 [entrez]
PHST- 2011/12/17 06:00 [pubmed]
PHST- 2012/12/13 06:00 [medline]
AID - 10.1007/s10840-011-9639-0 [doi]
PST - ppublish
SO  - J Interv Card Electrophysiol. 2012 Aug;34(2):197-204. doi: 
      10.1007/s10840-011-9639-0. Epub 2011 Dec 17.