Cardiac Resynchronization Therapy

Cardiac resynchronization therapy (CRT) is the state-of-art alternative therapy to many patients with drug-refractory advanced heart failure. This proven therapy, in no doubt, improves left ventricular systolic function, heart failure symptoms, and exercise tolerance, and decreases rehospitalization for heart failure and mortality. Correction of left ventricular electrical and mechanical dyssynchronization, which often accompany cardiomyopathy, is the fundamental mechanism for CRT. Recently published CRT trials for patients with mild-to-moderate heart failure symptoms have further demonstrated the benefits of this therapy in those patients with less severe heart failure. Early utilization of CRT may reverse left ventricular remodeling and reduce the occurrence of heart failure symptoms. Yet, this enthusiasm has been tempered by the observation that approximately one-third of CRT recipients may not be benefit from this therapy. This chapter will comprehensively review the CRT implant techniques, patient selection, and measures that will enhance the utilization and clinical outcomes of this therapy.