ACCF/HRS/AHA/ASE/HFSA/SCAI/SCCT/SCMR 2013 Appropriate Use Criteria for Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascul
The American College of Cardiology Foundation in colla e38 boration with the Heart Rhythm Society and key specialty and subspecialty societies conducted a review of common clinical scenarios where implantable cardioverter e39 defibrillators (ICDs) and cardiac resynchronization therapy (CRT) are frequently considered. The clinical scenarios covered in this document address secondary prevention, primary prevention, comorbidities, generator replacement at elective replacement indicator, dual-chamber lCD, and CRT. The indications (clinical scenarios) were derived from common applications or anticipated uses, as well as from current clinical practice guidelines and results of snidies examining device implantation. The 369 indications in this document were developed by a multidisciplinary writing group and scored by a separate independent technical panel on a scale of 1 to 9 to designate care that is Appropriate (median 7 to 9), May Be Appropriate (median 4 to 6), and Rarely Appropriate (median 1 to 3). The final ratings reflect the median score of the 17 technical panel members: 45% of the indications were rated as Appropriate, 33% were rated May Be Appropriate and 22% were rated Rarely Appropriate. In general, Appropriate designations were assigned to scenarios for which clinical trial evidence and/or clinical experience was available that supported device implanta tion. By contrast, scenarios for which clinical trial evidence was limited or device implantation seemed reasonable for extenuating reasons were categorized as May Be Appro priate. Scenarios for which there were data showing harm, or no data were available, and medical judgment deemed device therapy ill-advised were categorized as Rarely Appropriate. For example, comorbidities including life expectancy and cognitive function impacted appropriate e45 ness ratings. The Appropriate Use Criteria for ICD/CRT have the potential to enhance physician decision making, healthcare delivery, and reimbursement policy. Furthermore, recognition of clinical scenarios rated as May Be Appropriate facilitates the identification of areas that would benefit from future research.
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- "by biventricular pacing is recommended, in addition to optimal medical therapy, in selected patients with CHF, advanced LV systolic dysfunction and prolonged QRS interval. CRT has been robustly shown to reduce symptoms, hospitalizations and mortality in randomized controlled trials of CHF patients  . The presence of a typical LBBB morphology of the QRS complex is a strong predictor of response to CRT with biventricular pacing, whereas RBBB morphology and non-specific intra-ventricular conduction disturbances are associated with a low rate of response   . "
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ABSTRACT: We report the case of a 56-year-old male with ischemic cardiomyopathy, severe left ventricular dysfunction and right bundle branch block (RBBB) with a wide QRS duration (180ms) who received dual-chamber implantable cardioverter-defibrillator for primary prevention of sudden death. After having placed the right ventricular lead in the middle of the inter-ventricular septum, a significant narrowing of QRS duration was observed, thus obtaining "de facto" a cardiac resynchronization therapy (CRT). This type of cardiac pacing could be an alternative to conventional CRT with left ventricular pacing in patients with wide QRS due to RBBB. The long-term effects of this RV only pacing strategy with ICD in patients with heart failure yet remain to be determined.
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- "Although the current UK guidelines for the use of CRT  (ejection fraction <35%, QRS >120msecs and NHYA symptoms 3 to 4) do not endorse the use of biventricular pacing in this patient population, we recommend that in heart transplant recipients who will require a higher percentage of RV pacing CRT be considered. Indeed the very recently updated ACC/HRS/AHA guidelines  on the appropriate use of ICD and CRT suggest that it may be appropriate to use biventricular pacing from the outset in patients with a pacemaker indication but preserved LV function in whom > 40% RV pacing is anticipated. We note a single case in the literature of CRT use post-transplant  "
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ABSTRACT: It is established that cardiac resynchronisation therapy (CRT) reduces mortality and hospitalisation and improves functional class in patients with NYHA class 3-4 heart failure, an ejection fraction of ≤ 35% and a QRS duration of ≥ 120ms. Recent updates in the American guidelines have expanded the demographic of patients in whom CRT may be appropriate. Here we present two cases of complex CRT; one with a conventional indication but occluded central veins and the second with a novel indication for CRT post cardiac transplant.
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ABSTRACT: Cardiac imaging is one of the basic pillars of modern cardiology. The potential list of scenarios where cardiac imaging techniques can provide relevant information is simply endless so it is impossible to include all relevant new features of cardiac imaging published in the literature in 2012 in the limited format of a single article. We summarize the year's most relevant news on cardiac imaging, highlighting the ongoing development of myocardial deformation and 3-dimensional echocardiography techniques and the increasing use of magnetic resonance imaging and computed tomography in daily clinical practice. Full English text available from:www.revespcardiol.org.
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