February 16, 2024
Cardiology by Dr. Feng Yongkang
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, the condition of some patients becomes particularly serious due to impaired electrical conduction in the heart. These patients will have a phenomenon on their electrocardiogram called left bundle branch block (LBBB). Simply put, the timing of contraction and relaxation of the heart muscle in the left ventricle is not consistent, so patients with heart failure 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 BBS 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 normal pacemaker. It is worth knowing that the ventricular ejection index of these patients is very low, usually less than 30%, and that their chances of sudden death due to sudden heart rhythm problems are relatively high. Implantable defibrillators and resynchronization therapy equipment are collectively referred to as dual The implantable ventricular resynchronization defibrillator (CRT-D) was born. Fifteen years ago, many large-scale controlled trials demonstrated that CRT-D can improve disease conditions and reduce mortality compared to drug treatment. Unfortunately, the follow-up time then was relatively short and the long-term clinical benefits are still unknown.
A long-term follow-up called RAFT was published in the January 2024 issue of the New England Journal of Medicine. 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 treated with CRT-D had lower overall mortality than patients with ICD. The focus this time is that most patients in the RAFT trial only have second-degree heart failure and relatively mild symptoms, however, in long-term follow-up, CRT-D still brings very clear clinical benefits. In other words, patients with BBB and heart failure who receive CRT-D at an early stage may bring greater clinical benefit.
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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