Abstract
Cardiac Resynchronisation Therapy (CRT) is a treatment option for patient with congestive heart failure in NYHA class III and IV with signs of asynchrony. Numerous studies have demonstrated the benefits in terms of improved exercise tolerance (CPX, 6 min walk test), quality of life, and reverse remodeling with improved left ventricular performance. In addition, the modulation of the pump function as the electromechanical mechanism of CRT lead to a reduction in plasma norepinephrine levels with lower number of malignant arrhythmias and shock delivery. The current indications consider medically refractory patients with idiopathic dilated or ischemic cardiomyopathy, prolonged QRS interval (=130 ms), left ventricular end-diastolic diameter (=55 mm) and impaired left ventricular ejection fraction (=35%). Up to 30% of patients undergoing device implantation according to the currently accepted implant criteria will show no substantial improvement. Patient selection is needed. In particular, echocardiography has been shown as the leading technology to identify possible responders for CRT therapy as well as to perform follow-ups and re-adjustments of the pacemaker settings (f.e. VV-delay optimization).
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