心脏再同步治疗发展的新时期

无疑，心脏再同步治疗（CRT）已成为当下心力衰竭非药物治疗的一线选择。一系列大规模临床试验以及我们亲身的临床实践都证实了CRT在改善心力衰竭患者症状，降低住院率和死亡率的卓越疗效。经过十几年的发展，CRT应用进入了一个全新时期，其远期发展可能关注于两个方面。一是在遵从现有指南的基础上，如何进一步提高CRT反应率，二是扩展CRT植入适应证，使潜在人群获益。

The new era of cardiac resynchronization therapy

Cardiac resynchronization therapy(CRT)is an effective treatment for patients with drug-refractory,chronic heart failure.Current guidelines consider CRT as a Class I indication for heart failure patients in New York Heart Association(NYHA)functional class Ⅲ to Ⅳ with depressed left ventricular(LV)ejection fraction≤0.35 and a wide QRS complex≥120 ms.However,there are relative large numbers of nonresponders to CRT.How to improve the responder rate in patients undergoing CRT according to current guidelines is a major task in the future.An integrated approach evaluating LV dysynchrony,total myocardial scar burden,and cardiac venous anatomy may refine the selection of potential responders to CRT.Moreover,to expand patient groups that might also benefit from CRT is also equally important.REVERSE and MADIT-Ⅱ trials have demonstrated that the effect of CRT to improve LV function and prevent heart failure progression in mildly symptomatic heart failure patients.Perhaps attenumion of disease progression will prove to he a successful new treatment strategy in heart failure patients in the future.In addition,other clinical conditions,such as atrial fibrillation patients,upgrading from right ventricular pacing,right-sided heart failure,and congenital heart disease,have also demonstrated clinical benefit from CRT.However,more data are needed in these subpopulations.