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Review
. 2019 Jul;8(3):220-227.
doi: 10.15420/aer.2018.62.3.

Improving Cardiac Resynchronisation Therapy

George Thomas  1 , Jiwon Kim  1 , Bruce B Lerman  1
Affiliations
Review

Improving Cardiac Resynchronisation Therapy

George Thomas et al. Arrhythm Electrophysiol Rev. 2019 Jul.

Abstract

CRT is a cornerstone of therapy for patients with heart failure and reduced ejection fraction. By restoring left ventricular (LV) electrical and mechanical synchrony, CRT can reduce mortality, improve LV function and reduce heart failure symptoms. Since its introduction, many advances have been made that have improved the delivery of and enhanced the response to CRT. Improving CRT outcomes begins with proper patient selection so CRT is delivered to all populations that could benefit from it, and limiting the implantation of CRT in those with a small chance of response. In addition, advancements in LV leads and delivery technologies coupled with multimodality imaging and electrical mapping have enabled operators to place coronary sinus leads in locations that will optimise electrical and mechanical synchrony. Finally, new pacing strategies using LV endocardial pacing or His bundle pacing have allowed for CRT delivery and improved response in patients with poor coronary sinus anatomy or lack of response to traditional CRT.

Keywords: Heart failure; His bundle pacing; biventricular defibrillator; biventricular pacemaker; cardiac resynchronisation; leadless pacing.

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Conflict of interest statement

Disclosure: GT reports Biotronik research grant and consulting. The other authors have no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Decision Tree for CRT Non-responders
Figure 2:
Figure 2:. Optimisation of CRT with Adaptive CRT and Speckle Tracking Strain Imaging in Non-responders
See this image and copyright information in PMC

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