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The therapy of heart failure now encompasses many different modalities and approaches, including (1) medications to control volume and decrease preload and afterload (improve symptoms), (2) medications to improve contractility (improve symptoms), (3) medications that affect the neurohormonal perturbations associated with heart failure (improve survival), and, more recently, devices to correct conduction system abnormalities and treat potentially lethal arrhythmias (improve symptoms and survival). The use of implantable defibrillators (ICD) results in significant improvements in survival. It is also clear that conduction disturbances occur in a large percentage of patients with heart failure. Left bundle branch block, in particular, results in a dyssynchronous left ventricular (LV) contraction with associated low cardiac output, worsening mitral regurgitation and accelerated cardiac remodeling. Cardiac resynchronization therapy (CRT) synchronizes the ventricular activation, resulting in improvements in symptoms and quality of life. However, before the publication of the COMPANION (The Comparison of Medical Therapy, Pacing and Defibrillation in Heart Failure trial), only an interesting meta-analysis of various CRT studies suggested a trend towards a reduction in mortality.

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2008-06-03   |   1,058 visitas   |   1 valoraciones

Vol. 3 Núm.1. Enero-Marzo 2008 Pags. 40-41 Rev Insuf Cardíaca 2008; III(1)