Naresh Sen
Narayana Hrudayalaya Institute of Medical Science, India
Title: Cardiac resynchronisation therapy
Biography
Biography: Naresh Sen
Abstract
Background: CRT (Cardiac Re-synchronization Therapy) has been approved beneficially in heart failure patients with refractory optimized medical therapy based on many studies. The guidelines have shown CRT is indicated in NYHA class IIIIV, QRS>150 ms, LBBB (Left bundle branch block) to improve heart functions, ventricular re-modeling and clinical symptoms. Purpose: Comparison of stress induced mechanical dys-synchrony between rate dependent LBBB and RBBB (Right bundle branch block) and beneficial role of CRT to improve LV function and reduce mortality. Method: Patients presenting dyspnea on exertion NYHA class I-II to III-IV by stress test, normal QRS to rate dependent LBBB or RBBB by Stress test or Dubutamine Stress Echo were studied. CRT on cardiac function was assessed by Cath-study, Echo and MRI (Magnetic Resonance Imaging). Result: 12-months observational study done on stress induced rate dependent LBBB and RBBB with worsening dys-synchrony and poor LV function were treated with CRT. Results have shown improved LV function in rate dependent LBBB patients (31±6%) vs. RBBB patients (4.5±4%) with P value<0.04. and reduce mortality among rate dependent LBBB with CRT vs. without CRT ( 5% vs. 20%) and another side mortality difference between rate dependent RBBB with CRT and without CRT were not found significantly. Conclusion: Stress induced rate dependent LBBB with mechanical dys-synchrony leads to heart failure is benefited by CRT than Rate dependent RBBB.
