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(Circulation. 2004;109:308-309.)
© 2004 American Heart Association, Inc.

Mini-Review: Expert Opinions

Cardiac Resynchronization Therapy

Helpful Now in Selected Patients With CHF

James T. Willerson, MD; Dean J. Kereiakes, MD

From St Luke’s Episcopal Hospital/Texas Heart Institute (J.T.W.), Houston, Tex, and the Carl and Edyth Lindner Center for Research and Education (D.J.K.), Ohio Heart Health Center, Cincinnati, Ohio.

Correspondence to James T. Willerson, MD, University of Texas Health Science Center at Houston, St. Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, Room B 524, Houston, TX 77030. E-mail suzy.lanier@uth.tmc.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Drs Leclercq and Hare¹ and Auricchio and Abraham² have comprehensively reviewed the state of cardiac resynchronization therapy (CRT). As they emphasize, this novel pacing approach to treat heart failure shortens or optimizes the atrioventricular interval necessary to resynchronize lateral-septal contractions and improves atrioventricular mechanical synchrony by abolishing late diastolic ventriculoatrial gradient and the "presystolic mitral regurgitation" that is often seen with ventricular dyssynchrony. Pacing from the left lateral wall produces early activation of the papillary muscle region and may decrease systolic mitral regurgitation. Relative optimization of ventricular loading conditions as provided by CRT improves myocardial efficiency at no increased oxygen cost and increases systolic function with little effect on diastolic function. In addition to the positive hemodynamic effects mentioned above, CRT reduces sympathetic activity and may induce "reverse remodeling" of the failing left ventricle. With CRT, optimal responders develop smaller left ventricles and contractility is improved in the subsequent days to weeks.

The CRT device has more sophisticated software and hardware than standard pacemakers and requires more extensive follow-up visits and, thus, a higher cost. The software allows storage of intracardiac electrograms and monitoring of a patient’s physical activity and heart rates and heart rate variability. It is anticipated in the future that selected respiratory characteristics, body temperature, and body water content might also be possible to obtain with advanced software currently under development.

CRT is indicated for selected patients with symptomatic heart failure. These patients should be in a functional New York Heart Association class III, they should have . . . [Full Text of this Article]

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