HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS REGISTER		Author Keyword(s) Vol Page [Advanced]

This Article Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Add article to my folders Download to citation manager Request Permissions Google Scholar Articles by Chung, R Articles by Henein, M Y PubMed PubMed Citation Articles by Chung, R Articles by Henein, M Y

Beyond dyssynchrony in cardiac resynchronisation therapy

¹ Royal Brompton Hospital, London, UK
² St Mary’s Hospital, Paddington, London, UK
³ Heart Centre, University Hospital, Umeå, Sweden

Correspondence to:
Dr M Y Henein, Heart Centre, University Hospital, Umeå, Sweden; henein{at}googlemail.com

ABSTRACT
Cardiac resynchronisation therapy (CRT) in the form of biventricular pacing has emerged as a therapeutic option for patients with refractory heart failure. Patient selection and optimisation for CRT is based on the measurement of electromechanical ventricular dyssynchrony by electrocardiogram and echocardiographic techniques. The final common pathway for raising cardiac output on exertion is to minimise isovolumic time and maximise useful diastolic filling time, but correction of dyssynchrony alone may not lead to global improvement in about one-third of patients. Insights into pressure relations and abnormal timing, as well as clinical management, may hold the key to optimum outcome.