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Optimisation of cardiac resynchronisation therapy: addressing the problem of “non-responders”
  1. D J Fox1,
  2. A P Fitzpatrick1,
  3. N C Davidson2
  1. 1Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK
  2. 2North West Regional Cardiac Centre, Wythenshawe Hospital, Manchester, UK
  1. Correspondence to:
    Dr David J Fox
    Manchester Heart Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; david.j.foxtalk21.com

Abstract

Cardiac resynchronisation therapy has become firmly established as a treatment for patients with symptomatic heart failure. Several randomised controlled trials and numerous observational studies have demonstrated improvements in exercise capacity and quality of life. Despite these advances it is clear that approximately 25% of patients who meet current criteria for implantation of such a device do not show objective evidence of clinical benefit. Implantation of a CRT device is expensive, time consuming and involves some risk so it is important to accurately identify patients who are likely to respond and to optimise pacing lead placement and device programming to maximise the benefit in these selected patients.

  • AV, atrioventricular
  • CRT, cardiac resynchronisation therapy
  • LBBB, left bundle branch block
  • LV, left ventricular
  • NYHA, New York Heart Association
  • RBBB, right bundle branch block
  • TDI, tissue Doppler imaging
  • Vo2max, maximal oxygen uptake
  • heart failure
  • left bundle branch block
  • pacing

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Footnotes

  • * Many of the large multicentre trials (COMPANION, PATH CHF, MIRACLE, MUSTIC) adopted a policy of inclusion which ranged from > 120 ms to > 150 ms.11–14