Cardiac Resynchronization Therapy (CRT) is an effective, reliable device treatment in a selected patient population with symptomatic heart failure, reduced left ventricular ejection fraction (HFrEF), and wide QRS. Despite having clear evidence based on the last 20 years’ experiences for optimal patient selection, there have been still debated areas about special subgroups and device types. Moreover, due to aging, wider indications and the substantial change in the concomitant drug use and device treatments all led to a need for reconsidering the circumstances of CRT use.
In the current guidelines, there is a lack of detailed evidence for patients with a cardiac electronic implantable device (CIED) and a need for a CRT upgrade. At the same time, new techniques such as conduction system pacing could be an alternative option or more for such patients. The selection of CRT devices with or without a defibrillator (CRT-P vs. CRT-D) is still based on the physicians' discretion, when several parameters should be assessed individually before the implantation. Moreover, the prediction of response is multifactorial, in which assessing the optimal baseline patient characteristics (e.g. ECG morphology or HF etiology), circumstances of the operations (e.g. lead positions, interlead delays, multipolar pacing, use of antibiotics, etc.), and the individualized setting parameters (use of remote monitoring, dynamic AV-VV delay, etc.) or close follow-up can influence the outcome.
The definition of response is also variable, including functional or more objective measurements such as improvement of left ventricular function. The magnitude of response can be influenced by factors such as underlying etiology, comorbidities, and sex. The same amount of reverse remodeling might be classified as adequate response in a male patient with ischemic heart failure and renal insufficiency whereas the result may be an underachievement in a female patient with non-ischemic dilated cardiomyopathy. When individual decision making is involved to such a great extent in everyday clinical practice, state-of-art techniques such as machine-learning-based methods can also help the physicians to choose the most beneficial and effective options.
This article collection aims to release and conclude the latest results about the response to CRT helping the physicians in those questions that are not entirely covered by the current guidelines. Showing interesting results from observational trials, meta-analyses, big databases, or prospective trials can provide data that can be implemented in everyday clinical practice and having examples of how patients can be treated individually at a higher level and with a patient-centered approach.
Suggested sub-topics within this collection include:
1) Optimal patient selection for CRT (by their baseline characteristics or special subgroups such as those with CIED).
2) CRT upgrade.
3) Individualized treatment (risk stratification).
4) The optimal choice of device type (CRT-P vs. CRT-D).
5) Optimal patient selection for an alternative of CRT such as conduction system pacing (His-Purkinje, LBBB area).
6) Prediction of subsequent response to CRT (e.g. biomarkers).
7) The relevance of operational parameters (lead positions, quadripolar leads, techniques for decreasing operational side effects and complications).
8) Individualized patient settings and treatment (follow-up, concomitant drug use).
Cardiac Resynchronization Therapy (CRT) is an effective, reliable device treatment in a selected patient population with symptomatic heart failure, reduced left ventricular ejection fraction (HFrEF), and wide QRS. Despite having clear evidence based on the last 20 years’ experiences for optimal patient selection, there have been still debated areas about special subgroups and device types. Moreover, due to aging, wider indications and the substantial change in the concomitant drug use and device treatments all led to a need for reconsidering the circumstances of CRT use.
In the current guidelines, there is a lack of detailed evidence for patients with a cardiac electronic implantable device (CIED) and a need for a CRT upgrade. At the same time, new techniques such as conduction system pacing could be an alternative option or more for such patients. The selection of CRT devices with or without a defibrillator (CRT-P vs. CRT-D) is still based on the physicians' discretion, when several parameters should be assessed individually before the implantation. Moreover, the prediction of response is multifactorial, in which assessing the optimal baseline patient characteristics (e.g. ECG morphology or HF etiology), circumstances of the operations (e.g. lead positions, interlead delays, multipolar pacing, use of antibiotics, etc.), and the individualized setting parameters (use of remote monitoring, dynamic AV-VV delay, etc.) or close follow-up can influence the outcome.
The definition of response is also variable, including functional or more objective measurements such as improvement of left ventricular function. The magnitude of response can be influenced by factors such as underlying etiology, comorbidities, and sex. The same amount of reverse remodeling might be classified as adequate response in a male patient with ischemic heart failure and renal insufficiency whereas the result may be an underachievement in a female patient with non-ischemic dilated cardiomyopathy. When individual decision making is involved to such a great extent in everyday clinical practice, state-of-art techniques such as machine-learning-based methods can also help the physicians to choose the most beneficial and effective options.
This article collection aims to release and conclude the latest results about the response to CRT helping the physicians in those questions that are not entirely covered by the current guidelines. Showing interesting results from observational trials, meta-analyses, big databases, or prospective trials can provide data that can be implemented in everyday clinical practice and having examples of how patients can be treated individually at a higher level and with a patient-centered approach.
Suggested sub-topics within this collection include:
1) Optimal patient selection for CRT (by their baseline characteristics or special subgroups such as those with CIED).
2) CRT upgrade.
3) Individualized treatment (risk stratification).
4) The optimal choice of device type (CRT-P vs. CRT-D).
5) Optimal patient selection for an alternative of CRT such as conduction system pacing (His-Purkinje, LBBB area).
6) Prediction of subsequent response to CRT (e.g. biomarkers).
7) The relevance of operational parameters (lead positions, quadripolar leads, techniques for decreasing operational side effects and complications).
8) Individualized patient settings and treatment (follow-up, concomitant drug use).