University of Ottawa Heart Institute, Ottawa, Canada.
Curr Opin Cardiol. 2012 Mar;27(2):137-42. doi: 10.1097/HCO.0b013e32834febd3.
Cardiac resynchronization therapy (CRT) can reduce morbidity and mortality in patients with heart failure. However, a proportion of patients do not respond to CRT. This review addresses important clinical questions regarding patient selection for CRT.
Three recent large randomized trials show that CRT reduces morbidity and mortality in patients with New York Heart Association (NYHA) functional class II heart failure. Observational studies and a recent meta-analysis suggest that patients with NYHA III heart failure and atrial fibrillation may benefit from CRT. However, atrioventricular node ablation should be considered in this population to ensure greater than 92% biventricular pacing. Data from clinical trials do not support the use of CRT in patients with baseline right bundle branch block (RBBB).
Careful selection of CRT candidates is vital to improve patient outcomes and reduce exposure to unnecessary complications. This review summarizes recent data on the selection of CRT candidates, with emphasis on patients with NYHA I and II heart failure, atrial fibrillation and RBBB.
心脏再同步治疗（CRT）可降低心力衰竭患者的发病率和死亡率。然而，一部分患者对 CRT 无反应。本综述针对 CRT 患者选择的重要临床问题进行探讨。
三项近期大型随机试验表明，CRT 可降低纽约心脏协会（NYHA）心功能 II 级心力衰竭患者的发病率和死亡率。观察性研究和近期荟萃分析表明，NYHA 心功能 III 级伴心房颤动的患者可能从 CRT 中获益。然而，在此人群中应考虑房室结消融以确保超过 92%的双心室起搏。临床试验数据不支持在基线存在右束支传导阻滞（RBBB）的患者中使用 CRT。
仔细选择 CRT 患者至关重要，这有助于改善患者预后并减少不必要的并发症。本综述总结了 CRT 患者选择的最新数据，重点关注 NYHA I 和 II 级心力衰竭、心房颤动和 RBBB 的患者。
