Key result
This review summarizes the current evidence for expanding the use of cardiac resynchronization therapy in patients with asymptomatic left ventricular dysfunction, atrial fibrillation, or narrow QRS.
Why the study?
Does cardiac resynchronisation therapy improve outcomes in patients with asymptomatic/minimal symptoms LV dysfunction, AF, narrow QRS, RBBB, or end-stage renal failure?
Does cardiac resynchronisation therapy improve outcomes in patients with asymptomatic/minimal symptoms LV dysfunction, AF, narrow QRS, RBBB, or end-stage renal failure?
This review summarizes the evolving evidence for expanding CRT indications beyond traditional severe, symptomatic heart failure with wide QRS.
Evidence for CRT expansion in asymptomatic LV dysfunction, AF, or narrow QRS remains limited; leaves open whether broader use improves outcomes.
Current guidelines recommend cardiac resynchronisation therapy (CRT) for patients with severe left ventricular dysfunction (left ventricular ejection fraction [LVEF] ≤35 %), QRS duration of ≥120-150 ms (Class IA and IB indications) on surface electrocardiogram (ECG) and New York Heart Association (NYHA) class III or IV heart failure (HF) symptoms. Ongoing studies aim to expand the use of CRT in patients with asymptomatic or minimal symptoms left ventricular dysfunction. There have been studies that have shown benefit of CRT extended to this group of patients. There have also been different implications of the role of CRT in patients with atrial fibrillation (AF), patients with narrow QRS duration or with right bundle branch block (RBBB) on surface ECG, as well as patients with end-stage renal failure on dialysis therapy. This article aims to review the current body of evidence of expanding use of CRT in these populations.
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Looi et al. (2014) conducted a review in Heart failure with left ventricular dysfunction. Cardiac resynchronisation therapy (CRT) was evaluated. This review summarizes the current evidence for expanding the use of cardiac resynchronization therapy in patients with asymptomatic left ventricular dysfunction, atrial fibrillation, or narrow QRS.
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