Rickard John, Wilkoff Bruce Larry
Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, OH, USA.
J Interv Card Electrophysiol. 2011 Jun;31(1):61-8. doi: 10.1007/s10840-011-9555-3. Epub 2011 Mar 4.
Cardiac resynchronization therapy (CRT) has traditionally been reserved for patients with left ventricular (LV) dysfunction in the setting of advanced heart failure. Early clinical trials clearly demonstrated reverse ventricular remodeling and clinical benefits following CRT in this population. More recently, with the publication of the REVERSE, MADIT-CRT, and RAFT trials, the benefits of CRT have been demonstrated in patients with LV dysfunction and mild heart failure calling into question the optimal timing for biventricular pacemaker implantation. With the expanded indications for CRT arising from these studies, significant questions remain specifically with regards to the economic impact on health care systems and to the added risk of future morbidity due to device infection and malfunction.
传统上，心脏再同步治疗（CRT）一直用于晚期心力衰竭伴左心室（LV）功能障碍的患者。早期临床试验清楚地表明，该人群接受CRT治疗后出现了心室逆向重构并获得了临床益处。最近，随着REVERSE、MADIT-CRT和RAFT试验结果的公布，CRT在左心室功能障碍和轻度心力衰竭患者中的益处得到了证实，这使得双心室起搏器植入的最佳时机受到质疑。鉴于这些研究扩大了CRT的适应症，仍然存在重大问题，特别是在对医疗保健系统的经济影响以及因设备感染和故障导致未来发病风险增加方面。
