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Cardiac resynchronization therapy in heart failure: Implantation and other considerations

Leslie A Saxon, MD
Teresa DeMarco, MD
Section Editor
Wilson S Colucci, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


Medical therapies, such as angiotensin converting enzyme inhibitors, beta blockers, and spironolactone, have led to marked improvements in both symptom control and overall survival in patients with heart failure (HF). (See "Overview of the therapy of heart failure with reduced ejection fraction".)

Implanted devices, such as cardioverter-defibrillators (ICDs) and pacemakers, can also be beneficial. In particular, ICDs are now recommended for primary prevention of sudden cardiac death in selected patients with ischemic and nonischemic cardiomyopathy. (See "Primary prevention of sudden cardiac death in heart failure and cardiomyopathy", section on 'Use of an ICD'.)

In addition, some HF patients with bundle branch block benefit from simultaneous pacing of both ventricles (biventricular) or left ventricular pacing. This approach is referred to as cardiac resynchronization therapy (CRT) [1-6]. CRT can be achieved with a device designed only for pacing or can be incorporated into a combination device with an ICD (figure 1).

CRT is recommended in patients with HF (New York Heart Association class I to IV), severe systolic dysfunction (eg, left ventricular ejection fraction ≤30 to 35 percent) and intraventricular conduction delay (eg, QRS >120 to 150 msec). (See "Cardiac resynchronization therapy in heart failure: Indications".) The rationale for CRT is that ventricular dyssynchrony can further impair the pump function of a failing ventricle. Resynchronization may improve pump performance and reverse the deleterious process of ventricular remodeling. (See "Rationale for and mechanisms of benefit of cardiac resynchronization therapy".)

The implantation technique for CRT and other considerations in the management of patients with HF will be reviewed here. Indications for CRT and studies evaluating standard dual-chamber pacing in HF and the possible role of CRT in patients with atrial fibrillation are discussed separately. (See "Cardiac resynchronization therapy in heart failure: Indications" and "Overview of cardiac pacing in heart failure" and "Cardiac resynchronization therapy in atrial fibrillation".)


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Literature review current through: Sep 2016. | This topic last updated: Mar 3, 2014.
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