Rademakers Leonard M, de Boeck Bart W L, Maessen Jos G, Prinzen Frits W
Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
Heart Fail Clin. 2008 Jul;4(3):333-45. doi: 10.1016/j.hfc.2008.02.008.
This article illustrates the highly interesting possibilities of cardiac resynchronization therapy (CRT) yet also discusses several problems for optimal implementation. The authors have presented possible strategies to improve CRT by designing and using better measurements of mechanical dyssynchrony or discoordination, leading to better patient selection. In addition, application of CRT can be improved by developing techniques to reach the optimal pacing site(s) easier and algorithms for easier programming of optimal atrioventricular delay and interventricular interval. Also, application of CRT in patients with less severe heart failure deserves further attention. Finally, the mechanism of ventricular interaction may open new fields of application of left ventricle-based pacing in patients who have heart failure, even with a narrow QRS complex.
本文阐述了心脏再同步治疗（CRT）极具吸引力的可能性，但也讨论了优化实施过程中的若干问题。作者提出了一些可能的策略，通过设计和采用更好的机械不同步或不协调测量方法来改进CRT，从而实现更精准的患者选择。此外，可通过开发更容易到达最佳起搏部位的技术以及更便于编程最佳房室延迟和心室间期的算法来改善CRT的应用。而且，CRT在心力衰竭症状较轻患者中的应用值得进一步关注。最后，心室相互作用机制可能为心力衰竭患者（即使QRS波群狭窄）基于左心室起搏开辟新的应用领域。
