Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Dipartimento Cardio-toraco-vascolare, Bologna.
Cardiology Division, 'Città della Salute e della Scienza di Torino' Hospital, Department of Medical Sciences, University of Turin, Turin.
J Cardiovasc Med (Hagerstown). 2024 Aug 1;25(8):601-608. doi: 10.2459/JCM.0000000000001650. Epub 2024 Jun 26.
Cardiac resynchronization therapy (CRT) represents an effective heart failure treatment, associated with reduction in mortality and heart failure hospitalizations. This Italian survey aimed to address relevant CRT issues.
An online survey was administered to AIAC members.
One hundred and five electrophysiologists participated, with a median of 40 (23-70) CRT implantations/year (33% in high-volume centres). Forty-five percent of respondents (especially working in high-volume centres) reported an increase in CRT implantations in the last 2 years, in 16% a decrease, and in 38% CRT remained stable. Seventy-five percent of respondents implanted CRT only in patients with European Heart Rhythm Association (EHRA) class I indications. All operators collected ECG and echocardiography before implantation. Eighty-five percent of respondents selected coronary sinus target vein empirically, whereas 10% used mechanical and/or electrical delay techniques. Physicians working in high-volume centres reported a lower failure rate compared with others (16 vs. 34%; P = 0.03). If the coronary sinus lead could not be positioned in the target branch, 80% placed it in another vein, whereas 16% opted for a surgical approach or for conduction system pacing (CSP). Eighty percent accomplished CRT optimization in all patients, 17% only in nonresponders. Regarding anticoagulation, high agreement with EHRA guidelines emerged.
CRT represents a valid therapeutic option in heart failure treatment. Nowadays, CRT implantations remain stable and are mainly performed in patients with class I indications. ECG remains the preferred tool for patient selection, whereas imaging is increasingly used to determine the left pacing target area. In most patients, the left ventricular lead can be successfully positioned in the target vein, but in some cases, the result can be unsatisfactory; however, the decision to explore alternative resynchronization approaches is rarely pursued.
心脏再同步治疗（CRT）是一种有效的心力衰竭治疗方法，可降低死亡率和心力衰竭住院率。这项意大利调查旨在解决相关 CRT 问题。
向 AIAC 成员进行在线调查。
105 名电生理学家参与了调查，中位数为每年 40 例（33%在高容量中心）CRT 植入术。45%的受访者（尤其是在高容量中心工作的受访者）报告在过去 2 年中 CRT 植入术增加，16%减少，38%保持稳定。75%的受访者仅在符合欧洲心脏病学会（EHRA）I 类适应证的患者中植入 CRT。所有操作者在植入前均采集心电图和超声心动图。85%的受访者凭经验选择冠状窦靶静脉，而 10%的受访者使用机械和/或电延迟技术。与其他中心相比，高容量中心的医生报告 CRT 失败率较低（16%对 34%；P=0.03）。如果冠状窦导线不能定位在靶支，则 80%将其放置在另一根静脉中，而 16%则选择手术方法或传导系统起搏（CSP）。80%的患者在所有患者中实现 CRT 优化，17%仅在无反应者中实现。关于抗凝治疗，与 EHRA 指南有高度一致性。
CRT 是心力衰竭治疗的有效治疗选择。如今，CRT 植入术保持稳定，主要用于 I 类适应证患者。心电图仍然是患者选择的首选工具，而影像学越来越多地用于确定左起搏靶区。在大多数患者中，左心室导线可以成功定位在靶静脉中，但在某些情况下，结果可能不理想；然而，很少有医生探索替代再同步方法。
