CARDIAC RESYNCHRONIZATION THERAPY: IMPROVING QUALITY OF LIFE AND SURVIVAL IN PATIENTS WITH HEART FAILURE

Abstract

Just 30 years ago, the hope for survival in patients with heart failure (CHF) was dismal and centered on heart transplantation as the ultimate therapy1.Some of the early hemodynamic studies of abnormal ventricular activation in dilated cardiomyopathy (DCM) patients were done by Xiao et alIn 1998 LeClerc and Cazeau demonstrated the acute hemodynamic effects of biventricular pacing in patients with end-stage heart failure19.Buoyed by the gratifying observation that systolic function is influenced by pacing the posterolateral LVsite, Yu et al turned their attention to changing the timing of atrial contraction as it relates to ventricular contraction.In previous trials lasting up to six months, CRT has shown decrease in symptoms and improvement in exercise capacity, quality of life, and ventricular function19,25,26.In Pakistan the hospital ‘package’ for a CRT implant can range from less than Rs. 400,000 for a CRT pacemaker to Rs. 1,200,000 for CRT Pacemaker-ICD combination.Ten studies have reported on CRT peri-implant morbidity and mortality. There were 13 deaths in 3,113 patients (0.4%).