Cardiac Resynchronization Therapy

Abstract

Heart failure can potentially complicate all forms of heart disease. Over the last 20 years, there has been a significant increase in both its incidence and prevalence due to the advancing age of the population and improved survival from coronary heart disease – the principal cause of heart failure. Despite improvements in pharmacologic management, many patients with heart failure have severe, resistant symptoms and their prognosis remains poor. Medical therapy consists of angiotensin converting enzyme inhibitors (ACEI), aldosterone antagonists, and β-blockers, all of which have been shown to reduce morbidity and mortality. Digoxin and loop diuretics provide symptomatic benefit only. More recently, however, prospective randomized clinical trials have shown that cardiac resynchronization therapy (CRT), also known as biventricular pacing, results in improvements in LV function, exercise capacity, quality of life and mortality in selected patients with heart failure. This chapter will describe the rationale for CRT, the features that predict a potential benefit from CRT, the technique of implantation and the equipment required for the procedure, the complications that may occur, the follow-up that is required, and finally, the evidence that currently exists that supports its use.