Indications for Cardiac Resynchronization Therapy: 2011 Update From the Heart Failure Society of America Guideline Committee

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• 作者：William G. Stevenson ; MD¹ ; Adrian F. Hernandez ; MD² ; Peter E. Carson ; MD³ ; James C. Fang ; MD⁴ ; Stuart D. Katz ; MD⁵ ; John A. Spertus ; MD ; MPH⁶ ; Nancy K. Sweitzer ; MD ; PhD⁷ ; W.H. Wilson Tang ; MD⁸ ; Nancy M. Albert ; RN ; PhD ; CNS⁹ ; Javed Butler ; MD¹⁰ ; Cheryl A. Westlake Canary ; RN ; PhD¹¹ ; Sean P. Collins ; MD ; MSc¹² ; Monica Colvin-Adams ; MD¹³ ; Justin A. Ezekowitz ; MBBCh¹⁴ ; Michael M. Givertz ; MD¹ ; Ray E. Hershberger ; MD¹⁵ ; Joseph G. Rogers ; MD² ; John R. Teerlink ; MD¹⁶ ; Mary N. Walsh ; MD¹⁷ ; Wendy Gattis Stough ; PharmD¹⁸ ; Randall C. Starling ; MD ; MPH⁸ ; ^{starlir@ccf.org}
• 关键词：Heart failure ; cardiac resynchronization therapy ; guidelines
• 刊名：Journal of Cardiac Failure
• 出版年：2012
• 出版时间：February 2012
• 年：2012
• 卷：18
• 期：2
• 页码：94-106
• 全文大小：176 K

文摘

Cardiac resynchronization therapy (CRT) improves survival, symptoms, quality of life, exercise capacity, and cardiac structure and function in patients with New York Heart Association (NYHA) functional class II or ambulatory class IV heart failure (HF) with wide QRS complex. The totality of evidence supports the use of CRT in patients with less severe HF symptoms. CRT is recommended for patients in sinus rhythm with a widened QRS interval (?50 ms) not due to right bundle branch block (RBBB) who have severe left ventricular (LV) systolic dysfunction and persistent NYHA functional class II-III symptoms despite optimal medical therapy (strength of evidence A). CRT may be considered for several other patient groups for whom evidence of benefit is clinically significant but less substantial, including patients with a QRS interval of ?20 to <150 ms and severe LV systolic dysfunction who have persistent mild to severe HF despite optimal medical therapy (strength of evidence B), some patients with atrial fibrillation, and some with ambulatory class IV HF. Several evidence gaps remain that need to be addressed, including the ideal threshold for QRS duration, QRS morphology, lead placement, degree of myocardial scarring, and the modality for evaluating dyssynchrony. Recommendations will evolve over time as additional data emerge from completed and ongoing clinical trials.