EP Summit 2014: Cardiac Resynchronization Therapy (CRT): What Is It and Who Is It For?

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Brett Atwater, MD

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EP Summit 2014: Cardiac Resynchronization Therapy (CRT): What Is It and Who Is It For?

  1. 1. Cardiac Resynchronization Therapy (CRT), What is it and Who is it For? Bre$  D.  Atwater,  M.D.   Assistant  Professor  of  Medicine   Duke  University  Medical  Center   Page 1
  2. 2. What is Cardiac Dyssynchrony? Page 2
  3. 3. What is Cardiac Dyssynchrony? •  Dyssynchrony is easily identified by the presence of a LBBB on ECG •  LBBB is present in ¼ of all HF patients Page 3
  4. 4. What is CRT? Page 4
  5. 5. How is CRT Implantation Performed? Page 5
  6. 6. How is CRT Implantation Performed? Page 6
  7. 7. Which Patient has a Class I Indication for CRT-D in 2014? A.  58 yo woman with nonischemic cardiomyopathy, NYHA class II HF, EF 25%, NSR, LBBB, QRS 168 msec B.  ) 62 yo man with ischemic cardiomyopathy, NYHA I HF, EF 30%, NSR, LBBB, QRS 147 msec C.  77 yo man with ischemic cardiomyopathy, NYHA III HF, EF 35%, NSR, IVCD, QRS 136 msec 0% A. 0% B. 0% C. Page 7
  8. 8. 2014 CRT-D Guidelines •  Class I: EF ≤ 35%, NYHA II-IV, NSR, LBBB, QRS ≥ 150 •  Class IIa: –  –  –  –  EF ≤ 35%, NYHA II-IV, NSR, LBBB, QRS 120-149 EF ≤ 35%, NYHA III-IV, NSR, non-LBBB QRS ≥ 150 EF ≤ 35%, AF, will obtain near 100% V pacing EF ≤ 35%, and need for >40% V pacing •  Class IIb: –  EF ≤ 30%,NYHA I, Ischemic CM, NSR, LBBB, QRS ≥ 150 –  EF ≤ 35%, NYHA III-IV, NSR, non-LBBB, QRS 120-149 –  EF ≤ 35%, NYHA II, NSR, non-LBBB, QRS 120-149 Page 8
  9. 9. What type of pacemaker? 56 yo woman with no cardiac history presents with fatigue. Echo shows LV EF of 45%. This patient should have: A.  A dual chamber (A and RV) pacemaker B.  A CRT pacemaker implanted 0% A. 0% B. Page 9
  10. 10. What About Patients with EF 35%- 50% •  Randomized study of RV only vs CRT pacing in patients with AV block and EF < 50% •  The HR for death or HF hospitalization for CRT-P was 0.73 Curtis AB et al. N Engl J Med 2013;368:1585-1593 Page 10
  11. 11. Questions/Comments? •  •  •  •  brett.atwater@duke.edu 919-684-8111 http://www.dukehealth.org/heart_center Appointments in Raleigh, Durham, or Lumberton – 1-888-HRT-DUKE Page 11

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