Cardiac resynchronization therapy pacemaker: critical appraisal of the adaptive CRT-P device

Georges E Daoud,1 Mahmoud Houmsse2 1Department of the Biomedical Research, 2Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA Abstract: Cardiac resynchronization therapy (CRT) is an effective and well-established therapy for patients suffering w...

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Autores principales:	Daoud GE, Houmsse M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2016
Materias:	Heart failure cardiac resynchronization therapy adaptive left and biventricular pacing Medical technology R855-855.5
Acceso en línea:	https://doaj.org/article/4e5182075bc84665acc37e0639fe3a77
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spelling	oai:doaj.org-article:4e5182075bc84665acc37e0639fe3a772021-12-02T01:49:20ZCardiac resynchronization therapy pacemaker: critical appraisal of the adaptive CRT-P device1179-1470https://doaj.org/article/4e5182075bc84665acc37e0639fe3a772016-01-01T00:00:00Zhttps://www.dovepress.com/cardiac-resynchronization-therapy-pacemaker-critical-appraisal-of-the--peer-reviewed-article-MDERhttps://doaj.org/toc/1179-1470Georges E Daoud,1 Mahmoud Houmsse2 1Department of the Biomedical Research, 2Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA Abstract: Cardiac resynchronization therapy (CRT) is an effective and well-established therapy for patients suffering with heart failure, left ventricular (LV) systolic dysfunction (ejection fraction ≤35%), and electrical dyssynchrony, demonstrated by a surface QRS duration of ≥120 ms. Patients undergoing treatment with CRT have shown significant improvement in functional class, quality of life, LV ejection fraction, exercise capacity, hemodynamics, and reverse remodeling of LV, and ultimately, morbidity and mortality. However, 30%–40% of patients who receive a CRT device may not show improvement, and they are termed as nonresponders. The nonresponders have a poor prognosis; several methods have been developed to try to enhance response to CRT. Echocardiography-guided optimization of CRT has not resulted in significant clinical benefit, since it is done at rest with the patient in supine position. An ideal optimization strategy would provide continuous monitoring and adjustment of device pacing to provide maximal cardiac resynchronization, under a multitude of physiologic states. Intrinsic activation of the right ventricle (RV) with paced activation of the RV, even in the setting of biventricular (BiV) pacing, may result in an adverse effect on cardiac performance. With this physiology, the use of LV-only pacing may be preferred and may enhance CRT. Adaptive CRT is a novel device-based algorithm that was designed to achieve patient-specific adjustment in CRT so as to provide appropriate BiV pacing or LV-only pacing. This article will review the goals of CRT optimization, and implementation and outcomes associated with adaptive CRT. Keywords: heart failure, cardiac resynchronization, therapy, adaptive, left and biventricular pacingDaoud GEHoumsse MDove Medical PressarticleHeart failurecardiac resynchronizationtherapyadaptiveleft and biventricular pacingMedical technologyR855-855.5ENMedical Devices: Evidence and Research, Vol 2016, Iss Issue 1, Pp 19-25 (2016)
institution	DOAJ
collection	DOAJ
language	EN
topic	Heart failure cardiac resynchronization therapy adaptive left and biventricular pacing Medical technology R855-855.5
spellingShingle	Heart failure cardiac resynchronization therapy adaptive left and biventricular pacing Medical technology R855-855.5 Daoud GE Houmsse M Cardiac resynchronization therapy pacemaker: critical appraisal of the adaptive CRT-P device
description	Georges E Daoud,1 Mahmoud Houmsse2 1Department of the Biomedical Research, 2Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA Abstract: Cardiac resynchronization therapy (CRT) is an effective and well-established therapy for patients suffering with heart failure, left ventricular (LV) systolic dysfunction (ejection fraction ≤35%), and electrical dyssynchrony, demonstrated by a surface QRS duration of ≥120 ms. Patients undergoing treatment with CRT have shown significant improvement in functional class, quality of life, LV ejection fraction, exercise capacity, hemodynamics, and reverse remodeling of LV, and ultimately, morbidity and mortality. However, 30%–40% of patients who receive a CRT device may not show improvement, and they are termed as nonresponders. The nonresponders have a poor prognosis; several methods have been developed to try to enhance response to CRT. Echocardiography-guided optimization of CRT has not resulted in significant clinical benefit, since it is done at rest with the patient in supine position. An ideal optimization strategy would provide continuous monitoring and adjustment of device pacing to provide maximal cardiac resynchronization, under a multitude of physiologic states. Intrinsic activation of the right ventricle (RV) with paced activation of the RV, even in the setting of biventricular (BiV) pacing, may result in an adverse effect on cardiac performance. With this physiology, the use of LV-only pacing may be preferred and may enhance CRT. Adaptive CRT is a novel device-based algorithm that was designed to achieve patient-specific adjustment in CRT so as to provide appropriate BiV pacing or LV-only pacing. This article will review the goals of CRT optimization, and implementation and outcomes associated with adaptive CRT. Keywords: heart failure, cardiac resynchronization, therapy, adaptive, left and biventricular pacing
format	article
author	Daoud GE Houmsse M
author_facet	Daoud GE Houmsse M
author_sort	Daoud GE
title	Cardiac resynchronization therapy pacemaker: critical appraisal of the adaptive CRT-P device
title_short	Cardiac resynchronization therapy pacemaker: critical appraisal of the adaptive CRT-P device
title_full	Cardiac resynchronization therapy pacemaker: critical appraisal of the adaptive CRT-P device
title_fullStr	Cardiac resynchronization therapy pacemaker: critical appraisal of the adaptive CRT-P device
title_full_unstemmed	Cardiac resynchronization therapy pacemaker: critical appraisal of the adaptive CRT-P device
title_sort	cardiac resynchronization therapy pacemaker: critical appraisal of the adaptive crt-p device
publisher	Dove Medical Press
publishDate	2016
url	https://doaj.org/article/4e5182075bc84665acc37e0639fe3a77
work_keys_str_mv	AT daoudge cardiacresynchronizationtherapypacemakercriticalappraisaloftheadaptivecrtpdevice AT houmssem cardiacresynchronizationtherapypacemakercriticalappraisaloftheadaptivecrtpdevice
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Cardiac resynchronization therapy pacemaker: critical appraisal of the adaptive CRT-P device

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