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StatPearls-/-ä 2024[Jan]; ä (ä): ä PMID33620850show ga
Heart failure is one of the major causes of morbidity and mortality worldwide, and it is associated with poor life expectancy, poor quality of life, and a higher economic burden on the healthcare system. Heart failure can result from several causes, but left ventricular systolic dysfunction is the major cause of heart failure. Over the past three decades, advances in the medical management of patients with heart failure with reduced ejection fraction have improved the survival of the patients, but the morbidity and mortality related to heart failure remained elevated. With an increase in the age of the population and advances in the treatment of ischemic heart diseases, the number of patients with heart failure continues to grow, which has introduced significant challenges to managing cardiac arrhythmia and advanced heart failure. In patients with heart failure with reduced ejection fraction, electromechanical dyssynchrony from intraventricular conduction delays leads to hemodynamic inefficiencies, which consequently worsen functional mitral regurgitation and left ventricular remodeling, eventually leading to poor outcomes. In the early 1990s, it was identified that electromechanical dyssynchrony plays a prominent role in heart failure, and pacing devices that stimulate several places in the heart at once could be utilized to offset this dyssynchrony and conduction delay. In the late 1990s, Auricchio and Kass first described the efficacy of multisite pacing in humans, which led to cardiac resynchronization therapy (CRT), the first use of artificial electrical stimulation for heart failure. Since then, cardiac resynchronization therapy (CRT) has been an important treatment modality for heart failure patients with reduced ejection fraction. In this review, we will discuss the use of implantable pacing devices in heart failure with a primary focus on biventricular pacing (cardiac resynchronization), and we will discuss the pathophysiology, indications, complications, and clinical significance.
StatPearls-/-ä 2024 ; ä (ä): ä
