Authors' objectives:

This report is intended to assess the existing evidence on the use of biventricular or tricameral pacemakers in the management of heart failure.

Authors' results and conclusions: The characteristics of the patients who were evaluated in cardiac resynchronization therapy (CRT) are: - Advanced heart failure, with New York Heart Association (NHYA) class III IV - No indication for heart transplantation. - Idiopathic dilated cardiomyopathy or secondary to chronic ischemia. - Ejection fraction equal or less than 35% in sinus rhythm. - Interventricular conduction disturbances, mainly with left bundle-branch block presence, and a QRS duration greater than 120 milliseconds, preferably equal or lower than 150 milliseconds. - Stable drug therapy regimen (at least for three months), before implantation, using any of the following drugs (unless otherwise contraindicated) - Angiotensin- converting enzyme inhibitors - Spironolactone - Beta-blockers - Digoxin - Diuretics The main clinical trials carried out to date found that CRT would achieve: - Decrease in mortality due to progressive heart failure of about 30% (a mortality reduction of about 30 to 20% at 2.5 years) - Clinically significant improvement in the distance walked after 6 minutes - Improvement in the NYHA functional class in relation to the control group - Improvement in the quality of life in relation to the control group (mild to moderate effect). - Improvement of the functional parameters (peak oxygen uptake, ejection fraction, ventricular volumes, mitral regurgitation) - Reduction in hospital admissions due to CHF and in the need for intravenous drugs as compared to the control group.

Authors' recommendations: In the subgroup of patients with severe HF with the described inclusion criteria, BPT decreases the symptoms, hospitalizations and overall mortality and improves the quality of life. Several North American Clinical Practice Guidelines at present accept BPT with level IIa evidence and classify the indication with Grade A (recommendation for which there is acceptable quality evidence). It is worth mentioning that these results can not be extrapolated to other patients with a less severe HF, for whom resynchronization therapy requires further evaluation. At present, due to the limited longitudinal follow-up of the studies that evaluated biventricular pacemakers and the lack of specially designed economic studies, there is not enough evidence to confirm long-term safety and BPT cost-effectiveness for patients with HF, especially in our country.

Authors' methods: Overview

Project Status: Completed

URL for project: http://www.iecs.org.ar/

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Argentina

Organisation Name: Institute for Clinical Effectiveness and Health Policy

Contact Address: Dr. Emilio Ravignani 2024, Buenos Aires - Argentina, C1414 CABA

Contact Name: info@iecs.org.ar

Contact Email: info@iecs.org.ar

Copyright: Institute for Clinical Effectiveness and Health Policy (IECS)