Document Detail

Cardiac resynchronization therapy in NYHA class IV heart failure.
MedLine Citation:
PMID:  19379637     Owner:  NLM     Status:  MEDLINE    
Clinical practice guidelines recommend cardiac resynchronization therapy (CRT) for ambulatory New York Heart Association (NYHA) class IV patients with a QRS duration >or= 120 ms and a left ventricular ejection fraction <or= 35%. Only two prospective, randomized trials have compared outcomes after CRT in NYHA class III and IV patients. CRT improved mortality, exercise capacity, and quality of life in class IV patients, but the 1-year mortality remained high. Patients in these trials were in sinus rhythm at randomization and most patients had a left bundle branch block. Less data are available for NYHA class IV patients with atrial fibrillation, right bundle branch block, and previous ventricular pacing. No prospective randomized data are available for the use of CRT as rescue therapy in inotrope-dependent patients, but several case series have reported promising results. It is likely that "rescue therapy" with CRT will be most beneficial when patients improve enough with CRT to allow reinstitution of angiotensin-converting enzyme inhibitors and beta blockers.
Michelle Khoo; Patricia A Kelly; JoAnn Lindenfeld
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current cardiology reports     Volume:  11     ISSN:  1534-3170     ISO Abbreviation:  Curr Cardiol Rep     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-21     Completed Date:  2009-07-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100888969     Medline TA:  Curr Cardiol Rep     Country:  United States    
Other Details:
Languages:  eng     Pagination:  175-83     Citation Subset:  IM    
University of Colorado Health Sciences Center, 1635 Aurora Court, F749, Aurora, CO 80045, USA.
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MeSH Terms
Bundle-Branch Block / diagnosis,  mortality,  therapy
Cardiac Pacing, Artificial / methods,  standards*
Defibrillators, Implantable / standards*
Exercise Tolerance
Heart Conduction System / physiopathology
Heart Failure / classification*,  mortality,  physiopathology,  therapy*
Pacemaker, Artificial
Practice Guidelines as Topic*
Quality of Life
Randomized Controlled Trials as Topic
Risk Assessment
Severity of Illness Index
Stroke Volume
Survival Analysis
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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