9. Cardiac Resynchronization Therapy: Indications for Treatment and Strategies for Optimizing Results

  1. Barry H. Greenberg1,
  2. Denise D. Barnard1,
  3. Sanjiv M. Narayan2 and
  4. John R. Teerlink3,4
  1. Sanjiv M. Narayan MB, MD, FRCP, FACC

Published Online: 14 SEP 2010

DOI: 10.1002/9780470669402.ch9

Management of Heart Failure

Management of Heart Failure

How to Cite

Narayan, S. M. (2010) Cardiac Resynchronization Therapy: Indications for Treatment and Strategies for Optimizing Results, in Management of Heart Failure (eds B. H. Greenberg, D. D. Barnard, S. M. Narayan and J. R. Teerlink), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/9780470669402.ch9

Editor Information

  1. 1

    Division of Cardiology, University of California, San Diego, California, USA

  2. 2

    University of California and Veterans Affairs Medical Center, San Diego, California, USA

  3. 3

    Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA

  4. 4

    School of Medicine, University of California, San Francisco, California, USA

Author Information

  1. University of California and Veterans Affairs Medical Center, San Diego, California, USA

Publication History

  1. Published Online: 14 SEP 2010
  2. Published Print: 8 OCT 2010

ISBN Information

Print ISBN: 9780470753798

Online ISBN: 9780470669402

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Keywords:

  • cardiac resynchronization therapy (CRT) - indications for treatment and strategies for optimizing results;
  • CRT, one of the most powerful modalities - to treat patients with systolic heart failure;
  • CRT, treating dys-synchrony using biventricular (BV) pacing - to resynchronize left and right ventricular activation;
  • clinical problem - ventricular dys-synchrony pathophysiology;
  • left ventricular dys-synchrony and hemodynamic impact;
  • acute benefits of CRT - hemodynamic;
  • electrical and mechanical synchrony discordance;
  • recently revised Class I and Class IIa indications - for CRT implantation;
  • dys-synchrony, in terms of right-to-left ventricular delay;
  • cost effectiveness of CRT

Summary

This chapter contains sections titled:

  • Introduction

  • The clinical problem: pathophysiology of ventricular dys-synchrony

  • Dys-synchrony explains the adverse effects of ‘traditional’ RV pacing

  • The clinical implementation of CRT

  • Clinical benefits of CRT

  • Clinical trial evidence to support CRT

  • Current indications for CRT

  • The first clinical dilemma — what is “response” to CRT?

  • The second clinical dilemma — how do we identify responders?

  • The third clinical dilemma — can we optimize CRT for a given patient?

  • Other clinical dilemmas in CRT

  • Cost effectiveness of CRT

  • Conclusions

  • Acknowledgements

  • References