CRT Optimization: What Is New? What Is Necessary?
CRT Optimization: What Is New? What Is Necessary?
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DOI：
10.1007/s11936-019-0751-2
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发表时间：
2019-07-25
影响因子：
--
通讯作者：
Mullens, Wilfried
中科院分区：
文献类型：
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作者：
Dauw, Jeroen;Martens, Pieter;Mullens, Wilfried
心脏起搏治疗（CRT）已被证明可以改善生活质量，减少心力衰竭住院治疗，并延长射血分数降低、接受最佳药物治疗和电不同步的选定心力衰竭患者的生命。为确保CRT患者的最大获益，应实施最优化护理。这首先要适当转诊和选择患者，了解左束分支阻滞和QRS≥ 150 ms与最大逆重构相关。LV电极导线（最好是四极）最好定位在后外侧位置。植入后，最佳器械程控应以最大双心室起搏为目标，在选定病例中，可能需要进一步优化电延迟。同样重要的是，实施全面的多学科心力衰竭护理，包括药物上调、远程监测、康复和患者教育。新的起搏策略，如内起搏器或希氏束起搏的作用仍然是正在进行的研究的主题。
Cardiac resynchronization therapy (CRT) has proven to improve quality of life, reduce heart failure hospitalization, and prolong life in selected heart failure patients with reduced ejection fraction, on optimal medical therapy and with electrical dyssynchrony. To ensure maximal benefit for CRT patients, optimization of care should be implemented. This begins with appropriate referring as well as selecting patients, knowing that the presence of left bundle branch block and QRS≥150ms is associated with the greatest reverse remodeling. The LV lead, preferably quadripolar, is best targeted in a postero-lateral position. After implantation, optimal device programming should aim for maximal biventricular pacing and in selected cases further electrical delay optimization might be of use. Even as important, is the implementation of thorough multidisciplinary heart failure care with medication uptitration, remote monitoring, rehabilitation, and patient education. The role of newer pacing strategies as endocardial or His-bundle pacing remains the subject of ongoing investigation.