Department of Cardiology, Faculty of Medicine, Ankara University, Ankara, Turkey.
Anatol J Cardiol. 2022 May;26(5):346-353. doi: 10.5152/AnatolJCardiol.2022.1647.
Cardiac resynchronization therapy is a treatment modality developed in the early 2000s that targets the mechanical and electrical dyssynchrony in heart failure with reduced ejection fraction patients. Appropriate patient selection conditions specified in the guidelines include measurement of left ventricular systolic dysfunction, QRS width, and assessment of functional classification. Despite consistent and increasing evidence sup-porting the use of cardiac resynchronization therapy in eligible patients, proportion of patients with the device is still not at the desired level. In addition, studies conducted in recent years have shown that the cardiac resynchronization therapy response of patients is quite heterogeneous and in echocardiographic follow-up, it was observed that reverse remodeling was not at the supposed level in approximately one-third of the patients. In order to change this result, which is due to many reasons, solutions such as using assistive imaging methods, providing optimal patient selection, trying different pacing techniques and post-procedural programming strategies (AV-delay and VV-delay optimization) have been the subject of debate. In this article, we aim to review the mechanisms that have been revealed regarding the differences in cardiac resynchronization therapy response and new pacing techniques-especially conduction system pacing-that may be preferred to resolve poor cardiac resynchronization therapy response.
心脏再同步治疗是 21 世纪初发展起来的一种治疗方式，针对射血分数降低的心力衰竭患者的机械和电不同步。指南中规定了合适的患者选择条件，包括左心室收缩功能障碍、QRS 宽度的测量和功能分类的评估。尽管有一致且不断增加的证据支持在符合条件的患者中使用心脏再同步治疗，但装置的使用比例仍未达到理想水平。此外，近年来的研究表明，患者的心脏再同步治疗反应存在很大的异质性，在超声心动图随访中，大约三分之一的患者观察到逆向重构未达到预期水平。为了改变这一结果，原因有很多，人们一直在探讨使用辅助成像方法、进行最佳患者选择、尝试不同起搏技术和术后程控策略（AV 延迟和 VV 延迟优化）等解决方案。在本文中，我们旨在回顾心脏再同步治疗反应差异的相关机制以及新的起搏技术——特别是传导系统起搏，这些技术可能更有助于解决心脏再同步治疗反应不佳的问题。
