Understanding non-response to cardiac resynchronisation therapy: common problems and potential solutions

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Abstract

Heart failure is a complex clinical syndrome associated with a significant morbidity and mortality burden. Reductions in left ventricular (LV) function trigger adaptive mechanisms, leading to structural changes within the LV and the potential development of dyssynchronous ventricular activation. This is the substrate targeted during cardiac resynchronisation therapy (CRT); however, around 30–50% of patients do not experience benefit from this treatment. Non-response occurs as a result of pre-implant, peri-implant and post implant factors but the technical constraints of traditional, transvenous epicardial CRT mean they can be challenging to overcome. In an effort to improve response, novel alternative methods of CRT delivery have been developed and of these endocardial pacing, where the LV is stimulated from inside the LV cavity, appears the most promising.

Original languageEnglish
JournalHeart Failure Reviews
Early online date24 Aug 2018
DOIs
Publication statusE-pub ahead of print - 24 Aug 2018

Keywords

  • CRT
  • Endocardial pacing
  • Heart failure
  • Non-responders

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