Cardiac resynchronization therapy: Part 2--issues during and after device implantation and unresolved questions.
Encouraged by the clinical success of cardiac resynchronization therapy (CRT), the implantation rate has increased exponentially, although several limitations and unresolved issues of CRT have been identified. This review concerns issues that are encountered during implantation of CRT devices, including the role of electroanatomical mapping, whether CRT implantation should be accompanied by simultaneous atrioventricular nodal ablation in patients with atrial fibrillation, procedural complications, and when to consider surgical left ventricular lead positioning. Furthermore, (echocardiographic) CRT optimization and assessment of CRT benefits after implantation are highlighted. Also, controversial issues such as the potential value of CRT in patients with mild heart failure or narrow QRS complex are addressed. Finally, open questions concerning when to combine CRT with implantable cardioverter-defibrillator therapy and the cost-effectiveness of CRT are discussed.
Bax
Jeroen J
JJ
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. jbax@knoware.nl
Abraham
Theodore
T
Barold
S Serge
SS
Breithardt
Ole A
OA
Fung
Jeffrey W H
JW
Garrigue
Stephane
S
Gorcsan
John
J
Hayes
David L
DL
Kass
David A
DA
Knuuti
Juhani
J
Leclercq
Christophe
C
Linde
Cecilia
C
Mark
Daniel B
DB
Monaghan
Mark J
MJ
Nihoyannopoulos
Petros
P
Schalij
Martin J
MJ
Stellbrink
Christophe
C
Yu
Cheuk-Man
CM
D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy; D001283:Atrioventricular Node; D002303:Cardiac Output, Low / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D004452:Echocardiography; D004554:Electric Countershock; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications; D010138:Pacemaker, Artificial; D011182:Postoperative Care; D016896:Treatment Outcome