title: Cardiac resynchronization by pacing: an electrical treatment of heart failure.
abstract: Various modalities of cardiac pacing have been proposed in the past to improve hemodynamics, either directly or indirectly. Some of these are conventional ways of cardiac stimulation, others such as biventricular or left ventricular pacing, represent dedicated pacing techniques. Left ventricular and biventricular pacing are successfully applied in those patients with congestive heart failure who have conduction disturbances (i.e. left bundle branch block) as they correct the ensuing intra- and interventricular dyssynchrony. This is the reason why these pacing modalities are described as cardiac resynchronization therapy. According to the results of a series of studies, the cardiac resynchronization therapy seems to have a favourable clinical impact in terms of quality of life, morbidity and hospitalization rate. On-going and future studies should assess the impact of resynchronization therapy on overall mortality and its cost-effectiveness profile in specific subgroups of patients. Other open issues regard (i) the convenience of using biventricular pacing as a pacing-alone therapy or in combination with ventricular defibrillation capability, especially for potential candidates to heart transplantation, and (ii) the ways to identify properly the responders to resynchronization therapy.
authors.affiliation: Istituto di Cardiologia, Università di Bologna, Azienda Ospedaliera S.Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy. cardio1@almadns.unibo.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.forename: Mauro
authors.initials: M
authors.lastname: Biffi
authors.forename: Cristian
authors.initials: C
authors.lastname: Martignani
authors.forename: Francesco
authors.initials: F
authors.lastname: Fallani
authors.forename: Cristiano
authors.initials: C
authors.lastname: Greco
authors.forename: Francesco
authors.initials: F
authors.lastname: Grigioni
authors.forename: Ivan
authors.initials: I
authors.lastname: Corazza
authors.forename: Pietro
authors.initials: P
authors.lastname: Bartolini
authors.forename: Claudio
authors.initials: C
authors.lastname: Rapezzi
authors.forename: Romano
authors.initials: R
authors.lastname: Zannoli
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
mesh_terms: D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D016896:Treatment Outcome