Cardiac Resynchronization Therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor: Cafer Zorkun, M.D., Ph.D. [2] Assistant Editor: Atif Mohammad, MD

Introduction

Cardiac resynchronization therapy is a relatively new mode of therapeutic modality currently being used particularly in patients with advanced heart failure.Bi-ventricular pacing or pacing one of the ventricles with bundle branch block is referred to as Cardiac Resynchronization Therapy.

Currently CRT has been approved in patients with advanced HF patients benefit from simultaneous pacing of both ventricles (biventricular or BiV pacing) or of one ventricle in patients with bundle branch block. This approach is referred to as cardiac resynchronization therapy (CRT) . CRT can be achieved with a device designed only for pacing or can be incorporated into a combination device with an ICD.

Cardiac Resynchronization therapy has been approved for patients with advanced heart failure NYHA class III,IIV or patients with LVEF <35% and with QRS delay >120 ms.It has gain FDA approval for patients with NYHA class I OR II heart failure in the setting of QRS delay.

Mechanism of Therapy

CRT has been known to benefit patients with left ventricular dyssynchrony.The mechanism is till unclear but it is known to improve contractile performance of cardiac chambers and hence result in reverse remodelling improving functional capacity and decreasing clinical outcomes of mortality and repeat hospitalizations.Basically, CRT causes robust cardiac myocyte depolarization as a result of cardiac resynchronization which improves cardiac systolic function causing contraction of the left ventricle and thus reducing wall stress and mitral regurgitation.This also improves ventricular remodelling to uptill 6 months later.

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