Antoniou Christos-Konstantinos, Xydis Panagiotis, Konstantinou Konstantinos, Magkas Nikolaos, Manolakou Panagiota, Dilaveris Polychronis, Chrysohoou Christina, Gatzoulis Konstantinos A, Tsioufis Costas
First Department of Cardiology, National and Kapodistrian University of Athens, Hippokrateion General Hospital Athens, Greece.
Am J Cardiovasc Dis. 2021 Aug 15;11(4):429-440. eCollection 2021.
Cardiac resynchronization therapy (CRT) constitutes a cornerstone to the treatment of advanced dyssynchronous heart failure (DyssHF); moreover it represents one of the few instances that a revolutionary approach was pursued, yielding previously unfathomable benefits to patients out of realistic therapeutic options. However, as is rather extensively established, nonresponse, or even negative response, to CRT continue to plague its course, precluding favourable effects in up to 40% of recipients, for a multitude of reasons. Given the scope of the issue of nonresponse, attempts to negate it by means of altering CRT delivery mode, and, more specifically, by introducing multipoint left ventricular pacing (MPP) have been focused on. Possible reasons for divergent trial results will be presented, as well as potential criteria for predicting whether MPP activation may reap additional benefits as compared to conventional biventricular pacing (BVP). Finally, an alternative framework for approaching CRT in general will be put forward, including advancements which in the (near) future may once more revolutionise heart failure treatment.
心脏再同步治疗（CRT）是晚期失同步心力衰竭（DyssHF）治疗的基石；此外，它是少数采用革命性方法的案例之一，在现实的治疗选择中为患者带来了前所未有的益处。然而，正如已广泛确立的那样，CRT的无反应甚至负反应继续困扰着其治疗过程，由于多种原因，高达40%的接受者无法获得良好效果。鉴于无反应问题的范围，人们一直致力于通过改变CRT的递送模式，更具体地说，通过引入多点左心室起搏（MPP）来消除该问题。将介绍试验结果存在差异的可能原因，以及预测MPP激活与传统双心室起搏（BVP）相比是否可能带来额外益处的潜在标准。最后，将提出一个总体上处理CRT的替代框架，包括在（不久的）将来可能再次彻底改变心力衰竭治疗的进展。
