Sidhu Baldeep S, Gould Justin, Sieniewicz Benjamin J, Porter Bradley, Rinaldi Christopher A
a Division of Imaging Sciences and Biomedical Engineering , King's College London , London , UK.
b Cardiology Department , Guys and St Thomas' NHS Foundation Trust , London , UK.
Expert Rev Cardiovasc Ther. 2018 Aug;16(8):607-615. doi: 10.1080/14779072.2018.1498783. Epub 2018 Jul 16.
A significant number of patients undergo upgrade to cardiac resynchronization therapy (CRT). These patients tend to differ from individuals undergoing de novo CRT implantations both in terms of their baseline demographics and the etiology underlying their heart failure. Areas covered: There are several factors that need to be considered when upgrading patients to CRT, such as, venous patency. Potentially, these conditions can cause issues which may result in procedures being more difficult than de novo implantations. This article discusses these issues and compares the rates of procedural-related complications for CRT upgrades and de novo implantations. It discusses the proportion of patients that are likely to respond to CRT with each intervention. Expert commentary: Understanding the relative risks of CRT upgrades versus de novo implantations is important to help operators select the correct initial device and counsel patients accordingly. Growing experience with image-guided implantations and endocardial pacing may prove to be particularly relevant to patients undergoing CRT upgrades.
相当数量的患者会升级为心脏再同步治疗（CRT）。这些患者在基线人口统计学特征和心力衰竭的潜在病因方面往往与初次接受CRT植入的个体有所不同。涵盖领域：在将患者升级为CRT时，有几个因素需要考虑，例如静脉通畅情况。这些情况可能会引发问题，导致手术比初次植入更加困难。本文讨论了这些问题，并比较了CRT升级和初次植入的手术相关并发症发生率。还讨论了每次干预后可能对CRT有反应的患者比例。专家评论：了解CRT升级与初次植入的相对风险，对于帮助操作人员选择正确的初始设备并据此为患者提供咨询非常重要。图像引导植入和心内膜起搏方面不断积累的经验可能对接受CRT升级的患者尤为重要。
