PLACE OF BIVENTRICULAR STIMULATION IN PATIENTS WITH CHRONIC HEART FAILURE: LITERATURE REVIEW
Introduction: Chronic heart failure (CHF) remains one of the most significant problems of modern cardiology. A promising method of treatment is cardiac resynchronization therapy (CRT), carried out by atrioventricular stimulation.
Objective: Analysis of literature data on the effect of myocardial dyssynchrony on the clinical status of patients with CHF and methods for its detection, efficacy and safety of CRT in the treatment of patients with refractory CHF.
Materials and research methods: Search strategy: A search was made for scientific publications in search engines PubMed, Scopus, Web of Science, Google Scholar, in the electronic scientific library ELIBRARY.ru, CyberLeninka. Search depth was 17 years (2001 - 2018). Inclusion criteria: reviews and meta-analyzes, the results of prospective studies conducted on large populations of patients using keywords: chronic heart failure, myocardial dissynchrony, biventricular stimulation, blockade of the left leg of the bundle of His. During the search, information was studied on the efficacy and safety use of CRT in patients with refractory CHF, the mechanisms of myocardial dyssynchrony development and its influence on the course of CHF, methods of its diagnosis, electrophysiological bases of CRT in intraventricular dissynchrony, methods of left ventricle electrode positioning.
Results: The use of CRT showed a significant reduction in symptoms, improved quality of life, reduced hospitalization and mortality in patients with CHF with severe systolic dysfunction of the left ventricle (LV) and the presence of inter-and intraventricular myocardial dyssynchrony. Despite the obvious advantages of CRT in patients with refractory CHF, there are contradictions in the evaluation of the clinical efficacy of this method of treatment, since the results on the effectiveness of the procedure in various clinical studies differ somewhat among themselves. The share of nonresponders has been established, according to different sources, it can be 20-30%.
Conclusions: The possibility of selecting patients for CRT using fairly simple methods available to a wide range of specialists and medical institutions is of practical importance, and the method confirms the reverse myocardial remodeling - increasing the LV ejection fraction (EF) and reducing heart chambers in most patients with echocardiography. At the same time, the most common causes of insufficient response to CRT are imperfect patient selection criteria, a large amount of fibrous myocardial damage, non-optimal device programming parameters, non-target positions of ventricular electrodes and a low percentage of true biventricular stimulation.
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Sabitov E.T., Dussupov A.A., Abdrahmanov A.S., Orekhov A.Yu. Place of biventricular stimulation in patients with chronic heart failure: literature review. Nauka i Zdravookhranenie [Science & Healthcare]. 2019, (Vol.21) 3, pp. 5-19.Related publications:
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