Management of heart failure after cardiac resynchronization therapy: integrating advanced heart failure treatment with optimal device function.
Cardiac resynchronization therapy (CRT) is an established adjunctive treatment for patients with systolic heart failure (HF) and ventricular dyssynchrony. The majority of recipients respond to CRT with improvements in quality of life, New York Heart Association functional class, 6-min walk test, and ventricular function. Management of HF after CRT may include up-titration of neurohormonal blockade and an exercise prescription through cardiac rehabilitation to further improve and sustain clinical outcomes. Diagnostic data provided by the CRT device may help to facilitate and optimize treatment. Initial nonresponder rates remain problematic. We suggest a simple step-by-step management and troubleshooting strategy that integrates device function with advanced HF therapy in patients who do not initially respond to CRT. This algorithm represents a new, comprehensive, collaborative approach between the HF and electrophysiology specialists to further improve and sustain outcomes in the field of CRT.
Aranda
Juan M
JM
Division of Cardiovascular Medicine, College of Medicine, University of Florida Health Science Center, Gainesville, Florida, USA. arandjm@medicine.ufl.edu
Woo
Gregory W
GW
Schofield
Richard S
RS
Handberg
Eileen M
EM
Hill
James A
JA
Curtis
Anne B
AB
Sears
Samuel F
SF
Goff
J Sean
JS
Pauly
Daniel F
DF
Conti
Jamie B
JB
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000465:Algorithms; D002303:Cardiac Output, Low / Q000150:complications / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D004568:Electrodiagnosis; D006801:Humans; D018377:Neurotransmitter Agents / Q000037:antagonists & inhibitors; D010138:Pacemaker, Artificial; D017211:Treatment Failure; D018754:Ventricular Dysfunction / Q000209:etiology
D000319:Adrenergic beta-Antagonists; D018377:Neurotransmitter Agents