Key result
Cardiac resynchronization therapy restores ventricular synchrony, decreasing septal wall dyskinesis, mitral regurgitation, and pulmonary capillary wedge pressure, and reversing ventricular modeling.
Cardiac resynchronization therapy improves hemodynamics and reverses ventricular remodeling in patients with left ventricular systolic dysfunction and conduction delays.
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May support CRT consideration in LV systolic dysfunction with wide QRS; leaves open need for randomized outcome trials.
About 30% of patients with left ventricular systolic dysfunction also have ventricular conduction delays (prolonged QRS duration greater than 0.12 second) most frequently seen as left bundle branch block. This intraventricular conduction delay causes nonsynchronous ventricular activation between the right ventricle and the left ventricle (or dyssychrony), compromising cardiac function. Cardiac resynchronization therapy, or biventricular pacing, is a recent intervention for ventricular dyssychrony that incorporates 3 leads for pacing the right atrium and simultaneous pacing of the right ventricle and left ventricle. Left ventricular lead placement can be difficult to implant because of coronary venous anatomy and can require longer procedure time for the patient. Restoring ventricular synchrony has been shown to decrease septal wall dyskinesis, decrease mitral regurgitation, increase left ventricular filling time, decrease pulmonary capillary wedge pressure, and reverse ventricular modeling.
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Lauren Saul (2007) conducted a review in Left ventricular systolic dysfunction with ventricular conduction delays. Cardiac resynchronization therapy was evaluated. Cardiac resynchronization therapy restores ventricular synchrony, decreasing septal wall dyskinesis, mitral regurgitation, and pulmonary capillary wedge pressure, and reversing ventricular modeling.
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