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Which Patients with AV Block Should Receive CRT Pacing?

  • Arrhythmia (D Spragg, Section Editor)
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Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

The benefits of cardiac resynchronization therapy (CRT) are well-established, with the majority of large clinical trials focused on individuals with advanced systolic heart failure and patients with prolonged QRS duration. The favorable outcomes from CRT have been expanded from initial investigations in patients with severe heart failure to those with milder degrees of heart failure. More recently, studies have evaluated whether there is benefit from CRT in individuals requiring ventricular pacing but with asymptomatic left ventricular dysfunction. Recent studies have demonstrated that biventricular pacing may be superior to right ventricular (RV) pacing in patients requiring pacing who have normal to mildly depressed left ventricular function. However, pacing-induced cardiomyopathy does not occur in all RV-paced patients. CRT non-responders account for about one-third of patients receiving this therapy. Moreover, the complexity of the procedure carries with it higher complication risks than conventional pacemaker implants, and hence routine CRT implantation may not be justified in the entire population. In this paper, we provide a comprehensive review of the physiology and consequences of RV pacing, the pathophysiology of pacing-induced cardiomyopathy, the benefits of CRT, and the factors that should be considered for CRT implantation in this population.

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Conflict of Interest

Dr. Tanyanan Tanawuttiwat declares no potential conflicts of interest relevant to this article.

Dr. Alan Cheng has received honoraria from Boston Scientific, Medtronic, and St. Jude Medical. He has served as an advisor to Medtronic.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 568, Baltimore, MD, 21287, USA

    Tanyanan Tanawuttiwat MD & Alan Cheng MD

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  1. Tanyanan Tanawuttiwat MD
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  2. Alan Cheng MD
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Correspondence to Alan Cheng MD.

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This article is part of the Topical Collection on Arrhythmia

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Tanawuttiwat, T., Cheng, A. Which Patients with AV Block Should Receive CRT Pacing?. Curr Treat Options Cardio Med 16, 291 (2014). https://doi.org/10.1007/s11936-013-0291-0

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