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Cardiac Resynchronization Therapy Update: Evolving Indications, Expanding Benefit?

  • Heart Failure (MR Mehra and E Joyce, Section Editors)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Cardiac resynchronisation therapy (CRT) is an effective intervention for appropriately selected patients with heart failure, but exactly how it works is uncertain. Recent data suggest that much, or perhaps most, of the benefits of CRT are not delivered by re-coordinating left ventricular dyssynchrony. Atrio-ventricular resynchronization, reduction in mitral regurgitation and prevention of bradycardia are other potential mechanisms of benefit that will vary from one patient to the next and over time. Because there is no single therapeutic target, it is unlikely that any single measure will accurately predict benefit. The only clinical characteristic that appears to be a useful predictor of the benefits of CRT is a QRS duration of >140 ms. Many new approaches are being developed to try to improve the effectiveness of and extend the indications for CRT. These include smart pacing algorithms, better pacing-site targeting, new sensors, multipoint pacing, remote device monitoring and leadless endocardial pacing. Whether CRT is effective in patients with atrial fibrillation or whether adding a defibrillator function to CRT improves prognosis awaits further evidence.

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Conflict of Interest

C. Butcher reports grant support from Boston Scientific and another support from Boston Scientific and Medtronic. Y. Mareev and T. Wong declare that they have no conflict of interest. V. Markides reports institutional support from St. Jude and Boston Scientific. M. Mason reports other support from Medtronic, Boston Scientific and St. Jude Medical. J. G. F. Cleland reports personal fees and non-financial support from Medtronic, non-financial support from Boston Scientific, and personal fees from Biotronik, Sorin and St. Jude.

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  1. Royal Brompton and Harefield NHS Foundation Trust, London, UK

    C. Butcher, Y. Mareev, V. Markides, M. Mason, T. Wong & J. G. F. Cleland

  2. National Heart and Lung Institute, London, UK

    C. Butcher, Y. Mareev, V. Markides, M. Mason, T. Wong & J. G. F. Cleland

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  1. C. Butcher
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  2. Y. Mareev
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Correspondence to J. G. F. Cleland.

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This article is part of the Topical Collection on Heart Failure

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Butcher, C., Mareev, Y., Markides, V. et al. Cardiac Resynchronization Therapy Update: Evolving Indications, Expanding Benefit?. Curr Cardiol Rep 17, 90 (2015). https://doi.org/10.1007/s11886-015-0641-5

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