Cardiac Resynchronization Therapy (CRT) in Cardiology

Introduction

Cardiac resynchronization therapy (CRT) is a treatment designed to improve the heart's efficiency in patients with heart failure and electrical conduction abnormalities. It involves the placement of a specialized pacemaker that helps synchronize the contractions of the heart’s ventricles.

Who Needs CRT?

CRT is primarily recommended for patients with: - Heart failure with reduced ejection fraction (HFrEF) (≤35%) - Wide QRS complexes (≥130 ms), especially with left bundle branch block (LBBB) - Persistent symptoms despite optimal medical therapy

How Does CRT Work?

  • A small device (CRT-P pacemaker or CRT-D defibrillator) is implanted under the skin.
  • Leads are placed in the right atrium, right ventricle, and a coronary vein for the left ventricle.
  • These lead placements help synchronize the contraction of the heart’s chambers, enhancing cardiac output and reducing heart failure symptoms.

Benefits of CRT

  • Improves symptoms of heart failure (less fatigue, breathlessness)
  • Enhances quality of life and exercise capacity
  • Reduces hospitalizations due to heart failure exacerbations
  • Prolongs survival in selected patients

Risks and Considerations

While CRT has many benefits, it is not suitable for every patient. Possible risks include: - Lead placement complications - Infection and bleeding at the device site - No response in some patients (non-responders)

Conclusion

CRT is a well-established therapy that significantly improves outcomes in carefully selected heart failure patients. If you have heart failure with conduction abnormalities, discuss CRT as a potential treatment with your doctor.

Source recommendations

1. American Heart Association Guidelines on Heart Failure

  1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
  2. https://www.heart.org/en/health-topics/heart-failure
  3. https://professional.heart.org/en/guidelines-and-statements
  4. https://www.heart.org/en/professional/quality-improvement/get-with-the-guidelines/get-with-the-guidelines-heart-failure
  5. https://professional.heart.org/en/science-news/-/media/832EA0F4E73948848612F228F7FA2D35.ashx

2. European Society of Cardiology Guidelines on Cardiac Pacing

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Cardiac-Pacing-and-Cardiac-Resynchronization-Therapy
  2. https://academic.oup.com/eurheartj/article/42/35/3427/6358547
  3. https://pubmed.ncbi.nlm.nih.gov/34455430/
  4. https://academic.oup.com/eurheartj/article/34/29/2281/401445
  5. https://pubmed.ncbi.nlm.nih.gov/23801827/

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