Institute of Vascular Medicine, Division of Cardiology and Heart Education And Research Training (HEART) Center, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, SAR.
Circ J. 2013;77(6):1364-9. doi: 10.1253/circj.cj-13-0398. Epub 2013 Apr 27.
Cardiac resynchronization therapy (CRT) is an effective therapy for advanced heart failure (HF) patients. The indications are well defined in recent guidelines and broadly indicate that CRT is suitable for chronic HF patients with left ventricular ejection fraction (EF) ≤35% and in NYHA class III or IV (Class I), and those with prolonged QRS duration ≥120 ms with left bundle branch block (LBBB) QRS morphology, or QRS duration ≥150 ms irrespective of QRS morphology (Class IIa). For patients with NYHA class II symptoms, CRT is recommended for patients with EF ≤30% and QRS duration ≥130 ms with LBBB QRS morphology (Class I, level of evidence: A), or QRS duration ≥150 ms irrespective of QRS morphology (Class IIa, level of evidence: A). However, CRT may benefit additional patients outside these criteria. In this review, we summarize the role of CRT in some subgroups, including patients with mild and moderate HF, upgrading to CRT from right ventricular (RV) pacing, bradycardia patients with routine pacing indications, congenital heart disease and specific cardiomyopathies. It is possible that CRT can give symptomatic and mortality benefits in some of these subgroups in the future and further clinical trials are warranted.
心脏再同步治疗（CRT）是治疗晚期心力衰竭（HF）患者的有效方法。最近的指南对其适应证进行了明确的定义，广泛表明 CRT 适用于左心室射血分数（EF）≤35%和 NYHA 心功能分级 III 或 IV 级（I 类）的慢性 HF 患者，以及伴有持续 QRS 时限≥120 ms 并呈左束支传导阻滞（LBBB）QRS 形态的患者，或无论 QRS 形态如何 QRS 时限≥150 ms 的患者（IIa 类）。对于 NYHA 心功能 II 级症状的患者，对于 EF≤30%且伴有 LBBB QRS 形态的 QRS 时限≥130 ms 的患者（I 类，证据水平：A），或无论 QRS 形态如何 QRS 时限≥150 ms 的患者（IIa 类，证据水平：A），建议行 CRT。然而，CRT 可能会使这些标准之外的其他患者获益。在这篇综述中，我们总结了 CRT 在一些亚组患者中的作用，包括轻度和中度 HF 患者、从右心室（RV）起搏升级为 CRT 的患者、有常规起搏适应证的心动过缓患者、先天性心脏病和特定心肌病患者。在未来，CRT 可能会使这些亚组中的一些患者在症状和死亡率方面获益，需要进一步的临床试验。
