Cardiac resynchronizing therapy. Selection of patients and their management after implantation of biventricular heart pacemaker

Abstract Chronic heart failure (CHF) - a widely spread manifestation of various forms of heart diseases - is characterized by high mortality. Prognosis is especially unfavorable in patients with wide QRS complex. Method of resynchronizing therapy was elaborated for the treatment of this group of patients in addition of medical therapy. Its efficacy for improvement of clinical course and prognosis of CHF was demonstrated in a number of randomized controlled trials. However according to some data in 30-45% of cases application of the method is associated with no clinical improvement or reversal of cardiac remodeling when standard criteria (left ventricular ejection fraction less or equal 35%, QRS 120-150 ms, functional class II-IV) are used for patients selection. In this review we consider possibilities of various methods of selection of patients providing maximal probability of efficacy. We also present analysis of techniques of detection of implantation site of left ventricular lead and various tactics of management of patients after implantation of biventricular pacemaker.