2024-02-15 19:41:46
February 16, 2024
There is no doubt that heart failure is a very serious disease, and the mortality rate of patients remains high. In recent years, many new drugs can not only improve patients’ heart function, but also reduce mortality. Unfortunately, some patients’ condition becomes particularly severe due to impairment of electrical conduction in the heart. These patients will have a phenomenon on their electrocardiogram called left bundle branch block (LBBB). Simply put, the contraction and relaxation times of the heart muscle in the left ventricle are inconsistent, so heart failure patients are more severely ill than some patients with normal electrocardiograms.
As early as 20 years ago, an implanted pacemaker called cardiac resynchronization was targeted at these LBBB heart failure patients. Cardiologists achieve resynchronization therapy by installing electrodes in the left and right ventricles. The surgical procedure is similar to that of a regular pacemaker. It should be known that the ventricular ejection index of these patients is very low, usually below 30%, and their chances of sudden death due to sudden cardiac rhythm problems are relatively high. Implantable defibrillators plus resynchronization therapy equipment are collectively referred to as dual The ventricular resynchronization implantable defibrillator (CRT-D) came into being. Fifteen years ago, many large-scale controlled studies have proven that CRT-D can improve disease conditions and reduce mortality compared with drug treatment. Unfortunately, the follow-up time back then was relatively short, and the long-term clinical benefits are still unknown.
In the January 2024 issue of the New England Journal of Medicine, a long-term follow-up called RAFT was published. This study involved more than 1,000 patients with heart failure and LBBB who were randomized to receive CRT-D or ICD treatment. The median follow-up for these patients was 7.7 years, and for those who survived, it was 13.9 years. The results showed that patients receiving CRT-D had a lower overall mortality than ICD patients. The focus this time is that most of the patients in the RAFT study have only second-grade heart failure and relatively mild symptoms. However, in long-term follow-up, CRT-D still brings very obvious clinical benefits. In other words, LBBB and heart failure patients receiving CRT-D at an early stage can bring more clinical benefits.
The author is a cardiologist
[信健康] CRT-D helps treat heart failure, professional information comes to the rescue! 【More health information: health.hkej.com】
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