Cardiac resynchronization therapy to prevent life-threatening arrhythmias in patients with congestive heart failure.
Various clinical data demonstrate that cardiac resynchronization therapy (CRT) provides a favorable structural as well as electrical remodeling. The CArdiac Resynchronization-Heart Failure study, which tested the pure effect of CRT (using CRT devices without the capability of defibrillation) clearly showed a significant reduction in the total mortality by partly preventing sudden cardiac death. The antiarrhythmic effects of CRT are explained, at least in part, by ionic and genetic modulation of ventricular myocytes. It has been revealed in animal experiments to mimic disorganized ventricular contraction that CRT reverses down-regulation of certain K(+) channels and abnormal Ca(2+) homeostasis in the failing heart. However, CRT can be proarrhythmic in some particular cases especially in the early phase of this therapy. According to our study, proarrhythmic effects after CRT can be observed in approximately 10% of patients. The relatively high incidence of the proarrhythmic effects of CRT may promote a trend toward selecting CRT-D rather than CRT-P.
Department of Medicine, Division of Cardiology, Faculty of Medicine, Kinki University, Osaka, Japan. kuritat@med.kindai.ac.jp
Takashi
T
Kurita
Takashi
T
Noda
Takeshi
T
Aiba
Ikutaro
I
Nakajima
Wataru
W
Shimizu
Koichiro
K
Motoki
Ryobun
R
Yasuoka
Shunichi
S
Miyazaki
Shiro
S
Kamakura
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control*; D001281:Atrial Fibrillation / Q000150:complications; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D017180:Tachycardia, Ventricular / Q000209:etiology