TY - JOUR
T1 - Cardiac resynchronization therapy
T2 - How did consensus guidelines from Europe and the United States evolve in the last 15 years?
AU - Boriani, Giuseppe
AU - Ziacchi, Matteo
AU - Nesti, Martina
AU - Battista, Antonella
AU - Placentino, Filippo
AU - Malavasi, Vincenzo Livio
AU - Diemberger, Igor
AU - Padeletti, Luigi
PY - 2018/6/15
Y1 - 2018/6/15
N2 - Cardiac resynchronization therapy (CRT) was proposed around 20 years ago, and its clinical use rapidly moved from pioneering experiences to randomized controlled trials (RCT). Since 2002 recommendations for CRT have been included in international consensus guidelines that even in an early phase recommended CRT as an effective treatment for improving symptoms, reducing hospitalizations and mortality in well-selected patients with wide QRS, left ventricular dysfunction and moderate to severe heart failure (NYHA classes III–IV), on optimal medical therapy. Subsequently the indications were extended to mild (NYHA class II) heart failure (associated with left ventricular dysfunction and wide QRS) and more recently also to appropriately selected patients with conventional indications for pacing having a left ventricular ejection fraction of 50% or less and NYHA class I–III. While all the guidelines strongly recommend CRT in case of LBBB with QRS duration >150 ms, lower strength of recommendations, with some heterogeneity, appears when QRS duration is 130–150 ms, especially if not associated with LBBB. Of note, according to recent guidelines, CRT is not recommended in case of QRS duration <130 ms, which is now the lower limit for candidacy to CRT, differently from the 120 ms limit used before. Despite consensus guidelines, many data indicate that CRT is still underused, with great heterogeneity in its implementation, both in North America and Europe, thus requiring a more organized patient referral.
AB - Cardiac resynchronization therapy (CRT) was proposed around 20 years ago, and its clinical use rapidly moved from pioneering experiences to randomized controlled trials (RCT). Since 2002 recommendations for CRT have been included in international consensus guidelines that even in an early phase recommended CRT as an effective treatment for improving symptoms, reducing hospitalizations and mortality in well-selected patients with wide QRS, left ventricular dysfunction and moderate to severe heart failure (NYHA classes III–IV), on optimal medical therapy. Subsequently the indications were extended to mild (NYHA class II) heart failure (associated with left ventricular dysfunction and wide QRS) and more recently also to appropriately selected patients with conventional indications for pacing having a left ventricular ejection fraction of 50% or less and NYHA class I–III. While all the guidelines strongly recommend CRT in case of LBBB with QRS duration >150 ms, lower strength of recommendations, with some heterogeneity, appears when QRS duration is 130–150 ms, especially if not associated with LBBB. Of note, according to recent guidelines, CRT is not recommended in case of QRS duration <130 ms, which is now the lower limit for candidacy to CRT, differently from the 120 ms limit used before. Despite consensus guidelines, many data indicate that CRT is still underused, with great heterogeneity in its implementation, both in North America and Europe, thus requiring a more organized patient referral.
KW - Atrial fibrillation
KW - Bundle branch block
KW - Cardiac resynchronization therapy
KW - Dyssynchrony
KW - Guidelines
KW - Heart failure
KW - QRS interval
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U2 - 10.1016/j.ijcard.2018.01.039
DO - 10.1016/j.ijcard.2018.01.039
M3 - Article
C2 - 29657035
AN - SCOPUS:85045315295
VL - 261
SP - 119
EP - 129
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -