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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Cardiac resynchronization therapy: clinical results and evolution of candidate selection

Christophe Leclercq1,*, Gabe B. Bleeker2, Cecilia Linde3, Erwan Donal1, Jeroen J. Bax2, Martin J. Schalij2 and Claude Daubert1

1 Département de Cardiologie et Maladies Vasculaires, Centre Cardio-Pneumologique, Hôpital Pontchaillou-CHU, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 09, France
2 Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
3 Department of Cardiology, Karolinska Univeristy Hospital, Stockholm, Sweden

* Corresponding author. Tel: +33 2 99 28 25 25; fax: +33 2 99 28 25 10. E-mail address: christophe.leclercq{at}chu-rennes.fr

Cardiac resynchronization therapy (CRT) is now a recommended treatment in patients with severe heart failure, a poor left ventricular (LV) ejection fraction and wide QRS of >120 ms. The implementation of CRT in the current guidelines for the treatment of chronic heart failure occurred after the results of different clinical trials including more than 4000 patients, especially the COMPANION and CARE-HF trials. These trials showed that CRT over and above optimal drug treatment improves symptoms, quality of life, exercise tolerance, but more importantly reduces mortality and morbidity. Another major finding was that CRT reverses LV remodelling, a major prognostic factor in heart failure. However, the rate of responders remains only 65–70%. So far, the only validated criterion of cardiac dyssynchrony is the QRS width on the surface ECG, which is probably not optimal. Echocardiographic techniques have shown interesting perspectives for optimizing patient selection, but still have to be validated. Moreover, new indications for CRT (patients with atrial fibrillation, narrow QRS, or mild heart failure) will probably be validated in the near future. The recent and future technical developments in the device will help to optimize the therapy and also to improve heart failure monitoring using sensors in the device and home monitoring by telephone or Internet.

Key Words: Cardiac resynchronization therapy • Heart failure • Cardiomyopathy • Echocardiography • Biventricular pacing • Remodelling


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