Cardiac resynchronization therapy for heart failure management.

Abstract

Heart failure (HF) is responsible for an immense burden on our healthcare system. The prevalence of this disease continues to increase as a result of an aging population, successful treatment of acute coronary syndrome, and the use of new pharmacotherapies. Although pharmacotherapy with angiotensin converting enzyme inhibitors and beta-blockers shows improvement in morbidity and mortality, the overall prognosis of these patients remains poor. Cardiac transplant has limited applicability. Conduction disturbances are frequent in patients with advanced heart failure and may cause worsening systolic function and ventricular dyssynchrony. Biventricular pacing to achieve cardiac resynchronization is a recent and promising therapy for HF patients with an intraventricular conduction defect. Randomized clinical trials have substantiated that cardiac resynchronization therapy (CRT) through biventricular pacing offers significant benefit in morbidity and mortality in a select group of HF patients. Because of the high incidence of sudden cardiac death in patients with severe HF, the combination biventricular pacing with implantable cardioverter defibrillator therapy will provide additional benefit. This article provides an overview of CRT with the intent of describing ventricular dyssynchrony, the benefits of CRT, and the implications for advanced practice nurses.