The role of cardiac resynchronization therapy in heart failure

The worldwide prevalence of heart failure is increasing in part due to an ageing population. In the developed world, heart failure affects 1-2% of the general population, accounting for 5% of adult hospital admissions. There is now convincing evidence supporting the beneficial effects of cardiac resynchronization therapy for the treatment of heart failure. Numerous observational studies, as well as a series of randomised controlled trials, have demonstrated the safety, efficacy, and long-term benefits for patients with chronic systolic heart failure who have broad QRS complexes and refractory symptoms despite optimal medical therapy. These studies have consistently demonstrated statistically significant improvements in quality of life, NYHA functional class, exercise tolerance, and left ventricular reverse remodeling. Recent evidence suggests that the benefit may at least in part be due to a reduction in mechanical dyssynchrony.