Abstract：
BACKGROUND: Cardiac resynchronization therapy (CRT) represents an effective heart failure treatment, associated with reduction in mortality and heart failure hospitalizations. This Italian survey aimed to address relevant CRT issues.
METHODS: An online survey was administered to AIAC members.
RESULTS: One hundred and five electrophysiologists participated, with a median of 40 (23-70) CRT implantations/year (33% in high-volume centres). Forty-five percent of respondents (especially working in high-volume centres) reported an increase in CRT implantations in the last 2 years, in 16% a decrease, and in 38% CRT remained stable. Seventy-five percent of respondents implanted CRT only in patients with European Heart Rhythm Association (EHRA) class I indications. All operators collected ECG and echocardiography before implantation. Eighty-five percent of respondents selected coronary sinus target vein empirically, whereas 10% used mechanical and/or electrical delay techniques. Physicians working in high-volume centres reported a lower failure rate compared with others (16 vs. 34%; P = 0.03). If the coronary sinus lead could not be positioned in the target branch, 80% placed it in another vein, whereas 16% opted for a surgical approach or for conduction system pacing (CSP). Eighty percent accomplished CRT optimization in all patients, 17% only in nonresponders. Regarding anticoagulation, high agreement with EHRA guidelines emerged.
CONCLUSIONS: CRT represents a valid therapeutic option in heart failure treatment. Nowadays, CRT implantations remain stable and are mainly performed in patients with class I indications. ECG remains the preferred tool for patient selection, whereas imaging is increasingly used to determine the left pacing target area. In most patients, the left ventricular lead can be successfully positioned in the target vein, but in some cases, the result can be unsatisfactory; however, the decision to explore alternative resynchronization approaches is rarely pursued.
METHODS: An online survey was administered to AIAC members.
RESULTS: One hundred and five electrophysiologists participated, with a median of 40 (23-70) CRT implantations/year (33% in high-volume centres). Forty-five percent of respondents (especially working in high-volume centres) reported an increase in CRT implantations in the last 2 years, in 16% a decrease, and in 38% CRT remained stable. Seventy-five percent of respondents implanted CRT only in patients with European Heart Rhythm Association (EHRA) class I indications. All operators collected ECG and echocardiography before implantation. Eighty-five percent of respondents selected coronary sinus target vein empirically, whereas 10% used mechanical and/or electrical delay techniques. Physicians working in high-volume centres reported a lower failure rate compared with others (16 vs. 34%; P = 0.03). If the coronary sinus lead could not be positioned in the target branch, 80% placed it in another vein, whereas 16% opted for a surgical approach or for conduction system pacing (CSP). Eighty percent accomplished CRT optimization in all patients, 17% only in nonresponders. Regarding anticoagulation, high agreement with EHRA guidelines emerged.
CONCLUSIONS: CRT represents a valid therapeutic option in heart failure treatment. Nowadays, CRT implantations remain stable and are mainly performed in patients with class I indications. ECG remains the preferred tool for patient selection, whereas imaging is increasingly used to determine the left pacing target area. In most patients, the left ventricular lead can be successfully positioned in the target vein, but in some cases, the result can be unsatisfactory; however, the decision to explore alternative resynchronization approaches is rarely pursued.
摘要：
背景：心脏再同步治疗（CRT）是一种有效的心力衰竭治疗方法，与死亡率和心力衰竭住院率降低相关。这项意大利调查旨在解决相关的CRT问题。
方法：对AIAC成员进行了一项在线调查。
结果：一百零五名电生理学家参加了，中位数为40（23-70）个CRT植入/年（高容量中心为33％）。45％的受访者（尤其是在大批量中心工作）报告说，在过去2年中，CRT植入量有所增加，下降16%，38％的CRT保持稳定。75％的受访者仅在具有欧洲心律协会（EHRA）I类适应症的患者中植入CRT。所有操作者在植入前采集心电图和超声心动图。85%的受访者根据经验选择冠状窦目标静脉，而10%使用机械和/或电气延迟技术。在高容量中心工作的内科医生报告说，与其他人相比，失败率较低(16vs.34%；P=0.03）。如果冠状窦导线无法定位在目标分支中，80%的人把它放在另一条静脉里，而16%的人选择了手术方法或传导系统起搏(CSP)。80%的患者完成了CRT优化，只有17％的人没有反应。关于抗凝,与EHRA指南达成高度一致。
结论：CRT是心力衰竭治疗的有效治疗选择。如今,CRT植入保持稳定，主要在具有I类适应症的患者中进行。心电图仍然是患者选择的首选工具，而成像越来越多地用于确定左起搏靶区。在大多数患者中，左心室导线可以成功定位在目标静脉中，但在某些情况下,结果可能不令人满意；然而，很少有人决定探索替代的再同步方法。
方法：对AIAC成员进行了一项在线调查。
结果：一百零五名电生理学家参加了，中位数为40（23-70）个CRT植入/年（高容量中心为33％）。45％的受访者（尤其是在大批量中心工作）报告说，在过去2年中，CRT植入量有所增加，下降16%，38％的CRT保持稳定。75％的受访者仅在具有欧洲心律协会（EHRA）I类适应症的患者中植入CRT。所有操作者在植入前采集心电图和超声心动图。85%的受访者根据经验选择冠状窦目标静脉，而10%使用机械和/或电气延迟技术。在高容量中心工作的内科医生报告说，与其他人相比，失败率较低(16vs.34%；P=0.03）。如果冠状窦导线无法定位在目标分支中，80%的人把它放在另一条静脉里，而16%的人选择了手术方法或传导系统起搏(CSP)。80%的患者完成了CRT优化，只有17％的人没有反应。关于抗凝,与EHRA指南达成高度一致。
结论：CRT是心力衰竭治疗的有效治疗选择。如今,CRT植入保持稳定，主要在具有I类适应症的患者中进行。心电图仍然是患者选择的首选工具，而成像越来越多地用于确定左起搏靶区。在大多数患者中，左心室导线可以成功定位在目标静脉中，但在某些情况下,结果可能不令人满意；然而，很少有人决定探索替代的再同步方法。
