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Cardiac resynchronization therapy in heart failure: Indications

Authors
Evan Adelstein, MD
Samir Saba, MD
Section Editor
Frederick Masoudi, MD, MSPH, FACC, FAHA
Deputy Editor
Susan B Yeon, MD, JD, FACC

INTRODUCTION

Cardiac resynchronization therapy (CRT) is a modality of cardiac pacing used in patients with left ventricular (LV) systolic dysfunction and dyssynchronous ventricular activation that provides simultaneous or nearly simultaneous electrical activation of the LV and right ventricle (RV) via stimulation of the LV and RV (biventricular pacing) or LV alone. This is performed by either a CRT-pacemaker (CRT-P) or by a combined CRT-implantable cardioverter-defibrillator (CRT-D). CRT devices include a transvenous pacing lead placed in a branch of the coronary sinus (or, less commonly, an epicardial or endocardial LV lead) for LV pacing, in addition to leads in the RV and right atrium. These leads are attached to a pulse generator typically located in the subcutaneous tissue of the upper chest. (See "Cardiac resynchronization therapy in heart failure: Implantation and other considerations".)

Many of the indications for implantable cardioverter-defibrillators (ICDs) overlap with those for CRT. The indications and evidence for ICD use are discussed separately. (See "Primary prevention of sudden cardiac death in heart failure and cardiomyopathy" and "Secondary prevention of sudden cardiac death in heart failure and cardiomyopathy" and "Sustained monomorphic ventricular tachycardia in patients with a prior myocardial infarction: Treatment and prognosis".)

CRT and ICD therapy are key components of the management of heart failure with reduced ejection fraction in addition to pharmacologic therapy, as discussed separately. (See "Overview of the therapy of heart failure with reduced ejection fraction".)

Use of CRT in patients with atrial fibrillation is discussed separately. (See "Cardiac resynchronization therapy in atrial fibrillation".)

RATIONALE FOR CRT

CRT involves pacing the left ventricle (LV) and usually simultaneous or nearly simultaneous pacing of the right ventricle to restore ventricular synchrony and thus improve LV systolic function and clinical outcomes for selected patients with LV systolic dysfunction and electrocardiographic evidence of electrical dyssynchrony. (See 'Evidence' below.)

                            
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Literature review current through: Nov 2017. | This topic last updated: Oct 31, 2017.
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