Interní Med. 2003; 5(1): 14-18 [Interv Akut Kardiol. 2002;1(2):96-99]

Resynchronizační terapie chronického srdečního selhání - souhrn dosavadních poznatků

MUDr. Přemysl ©váb, MUDr. Jaroslav ©imon
Kardiocentrum dospělých, oddělení invazivní kardiologie interní kliniky 2. LF UK a FN Motol, Praha

Keywords: chronic heart failure, resynchronization therapy, biventricular stimulation.

Published: December 31, 2003  Show citation

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©váb P, ©imon J. Resynchronizační terapie chronického srdečního selhání - souhrn dosavadních poznatků. Interní Med. 2003;5(1):14-18.

Resynchronizační terapie je nová nefarmakologická metoda léčby chronického srdečního selhání (CHSS). Historicky starąí způsob elektrické léčby srdečního selhání pomocí standardní dvoudutinové stimulace s optimalizovaným a-v intervalem není dosud obecně přijímán jako vhodná metoda léčby CHSS a je účinný pravděpodobně jen u malého počtu nemocných. Naproti tomu klinický prospěch biventrikulární stimulace (BSK) byl ověřen ve velkých randomizovaných studiích (PATCHF, MIRACLE, MUSTIC, CONTACK-CD). Tento způsob léčby významně zlepąuje toleranci zátěľe a kvalitu ľivota u nemocných s těľkým srdečním selháváním (NYHA III nebo IV), dilatovanou levou komorou a poruchou nitrokomorového vedení. Daląí nedávno zahájené velké studie CARE-HF (Evropa) a COMPANION (USA) by měly do dvou let přinést odpovědi na daląí otázky a zejména vyhodnotit dopad této léčby na celkovou mortalitu a morbiditu.

RESYNCHRONIZATION THERAPY FOR CHRONIC HEART FAILURE - SUMMARY OF CURRENT KNOWLEDGE

Resynchronization therapy represents a new nonpharmacological method for the treatment of chronic heart failure. Historically, the older modality of electric therapy for heart failure by the standard double chamber stimulation with optimal a-v interval has not been widely accepted as a suitable method for the treatment of heart failure and is efficient probably only in a small number of patients. On the other hand, the clinical benefit of biventricular stimulation has been proved in large randomized studies (PATCHF, MIRACLE, MUSTIC, CONTAKT-CD). This treatment modality significantly improves exercise tolerance, quality of life in patients with severe heart failure (NYHA III-IV), dilated left ventricle and intraventricular conduction delay. Other recently launched large studies, CARE-HF (in Europe) and COMPANION (in the USA), should, in two years time, give answers to other questions, especially the impact of this treatment on overall mortality and morbidity.

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