Béla Merkely
Past President of the Hungarian Society of Cardiology
Heart and Vascular Center, Semmelweis University, Hungary
Title: Cardiac Resynchronisation: State of the Art
Biography
Biography: Béla Merkely
Abstract
rnCardiac resynchronization therapy (CRT) has become the gold standard device therapy in chronic heart failure patients on optimal medical therapy with ventricular dyssynchrony and reduced ejection fraction. According to the ESC guidelines, CRT is most effective in patients with wide QRS (120-150 msec), left bundle branch block, non-ischemic etiology and female gender. CRT indication is growing across Europe, but CRT penetration is insufficient, thus CRT needs exerts CRT implantations. To compensate, both the numbers of CRT implanting centers and the overall CRT implantations increase rapidly in European countries. In 2013 a total of 51 274 CRT devices were implanted in 1701 national European centers.rnCRT is cost-effective, reduces mortality and morbidity, however non-response to CRT is still the biggest problem. Recent studies have showed no advantage of CRT in patients with narrow QRS or non-left bundle branch block pattern in ECG. Etiology of heart failure has a pivotal role, it has been shown that CRT with implantable cardioverter defibrillator (CRT-D) might be beneficial in patients with ischemic etiology, but not in non-ischemic patients. Device optimization is crucial, physiologic atrioventricular delay (<120 msec), and optimal electrode position (in a postero-lateral vein far away from the scar) reduces mortality. Electroanatomic mapping with right to left ventricular interlead sensed electrical delay measurement improves pacing conditions. Quadripolar lead configuration could avoid phrenic nerve stimulation. Novel implantation techniques have been developed, such as transseptal endocardial lead placement or coronary sinus lead stabilization with stent implantation.rn