[Cardiac resynchronization therapy for heart failure].

Abstract

The short-term prognosis of advanced refractory heart failure is extremely poor and closely correlated with progressive left ventricular dysfunction. The identification of the negative effects of conduction delay on cardiac performance, observed in almost 50% of heart failure patients, disclosed a new research field addressing the correction of electrical abnormalities in order to achieve an improvement in myocardial function. Biventricular stimulation, or cardiac resynchronization therapy, corrects the atrioventricular, inter- and intraventricular mechanical asynchrony and, to date, is indicated (class IIA, level of evidence A) for patients with NYHA class III-IV refractory heart failure regardless of its etiology, QRS interval > or = 130 ms, left ventricular end-diastolic diameter > or = 55 mm, and ejection fraction < or = 35%. To date, the completed trials demonstrated in patients undergoing biventricular pacing a significant improvement in left ventricular performance, quality of life and NYHA class with no significant effects on total mortality. The identification of non-responders (approximately 20-30% of the patient population in completed trials) represents an unresolved issue of cardiac resynchronization therapy. Tissue Doppler imaging evaluation of left ventricular dyssynchrony, which is being addressed by non-randomized prospective studies, should drastically decrease the percentage of these patients.