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Cardiac resynchronization therapy in heart failure patients
Cardiac resynchronization Therapy (CRT) is an established device treatment for a well-selected patient population, especially for those with heart failure with reduced ejection fraction (HFrEF) and Left Bundle Branch Block (LBBB). At the same time, recommendations are weak for those, who have been already implanted a conventional pacemaker (PM) or an implantable cardioverter defibrillator (ICD), the current guidelines provide a IIaB indication for a CRT upgrade, which have been modified several times in the last years. These changes clearly showed an unmet need for more robust data. The BUDAPEST CRT Upgrade trial is the first, which aimed to investigate the efficacy and safety on CRT upgrade in patients with HFrEF, already implanted a PM or ICD with an intermittent or permanent right ventricular (RV) pacing. As the BUDAPEST CRT Upgrade trial revealed, these patients characterized a very advanced-stage HF cohort, in whom the CRT-D upgrade substantially reduced the risk of HF hospitalisations, deaths, and the absence of reverse remodelling as compared to ICD alone. Moreover, echocardiographic left ventricular parameters significantly improved in the CRT-D arm, which was also associated with a lower incidence of VT/VF events as compared to ICD alone.
Overall, in those HFrEF patients with a PM or ICD and intermittent or permanent RV pacing, CRT-D upgrade reduces the risk of further adverse events such as mortality, heart failure hospitalisation or LV remodelling, therefore we should strictly follow our patients and perform the CRT upgrade immediately without postponing it to a later date.
Biography
Professor Béla Merkely has been the Rector of Semmelweis University since 2018, the Chairman and the Director of Semmelweis University’s Heart and Vascular Centre since 2007. He is the Honorary President and the former President of the Hungarian Society of Cardiology and the Hungarian Heart Rhythm Association; the former President of the Hungarian Association of Percutaneous Cardiovascular Intervention, and the President of the Cardiology Section of the Professional College. Between 2014 and 2016 he was Councillor, between 2016 and 2018 he was Vice-President of the European Society of Cardiology.
His major research interests are the non-pharmacological treatment of heart failure; new techniques in interventional cardiology; invasive and non-invasive imaging in heart failure; arrhythmias and acute coronary syndromes; sport cardiology, cardiac remodelling of elite athletes.
He has authored and co-authored five books, 48 book chapters, has contributed to 22 university coursebook chapters and two university textbooks, and has written over 1140 articles in international and Hungarian medical journals. His cumulative impact factor is 5948,84, the number of his independent citations is 68.423.
He has earned numerous awards and honours, including the Széchenyi Prize in 2021, the Order of Merit of the Republic of Hungary (Commander Cross) in 2016, the Honorary citizenship of Budapest in 2013, the Elite Reviewer of the Europace Journal in 2012, the Order of Merit of the Republic of Hungary, Officer’s Cross in 2011, the Nivou Prize of the Hungarian Academy of Sciences in 2009.
As a clinician, Professor Merkely performs diagnostic coronarographies, PCIs, pacemaker, ICD, CRT, TAVI and Mitraclip implantations.
Website: https://semmelweis.hu/english/ and https://semmelweis.hu/varosmajor/en/