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Open Access 01-03-2020 | Left Bundle Branch Block

Prevention of non-response to cardiac resynchronization therapy: points to remember

Authors: Huolan Zhu, Tong Zou, You Zhong, Chenguang Yang, Yirong Ren, Fang Wang

Published in: Heart Failure Reviews | Issue 2/2020

Abstract

Cardiac resynchronization therapy (CRT) is an important and effective therapy for end-stage heart failure. Non-response to CRT is one of the main obstacles to its application in clinical practice. There is no uniform consensus or definition of CRT “response.” Clinical symptoms, ventricular remodeling indices, and cardiovascular events have been reported to be associated with non-responders. To prevent non-response to CRT, three aspects should be thoroughly considered: preoperative patient selection, electrode implantation, and postoperative management. Preoperative selection of appropriate patients for CRT treatment is an important step in preventing non-response. Currently, the CRT inclusion criteria are mainly based on the morphology of QRS waves in deciding ventricular dyssynchrony. Echocardiography and cardiac magnetic resonance are being explored to predict nonresponse to CRT. The location of left ventricular electrode implantation is a current hot spot of research; it is important to identify the location of the latest exciting ventricular segment and avoid scars. Cardiac magnetic resonance and ultrasonic spot tracking are being progressively developed in this field. Some new techniques such as His Bundle pacing, endocardial electrodes, and novel sensors are also being investigated. Postoperative management of patients is another essential step towards preventing non-response; it mainly focuses on the treatment of the disease itself and CRT program control optimization. CRT treatment is just one part of the overall treatment of heart failure, and multidisciplinary efforts are needed to improve the overall outcome.

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Title: Prevention of non-response to cardiac resynchronization therapy: points to remember
Authors: Huolan Zhu
Tong Zou
You Zhong
Chenguang Yang
Yirong Ren
Fang Wang
Publication date: 01-03-2020
Publisher: Springer US
Keywords: Left Bundle Branch Block
Heart Failure
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Cardiac Resynchronization Therapy
Published in: Heart Failure Reviews / Issue 2/2020
Print ISSN: 1382-4147
Electronic ISSN: 1573-7322
DOI: https://doi.org/10.1007/s10741-019-09834-w

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