Cardiac resynchronization therapy: strategies for device programming, troubleshooting and follow-up

Cardiac resynchronization therapy (CRT) improves symptoms, exercise performance, ventricular function, and survival in patients with left ventricular dysfunction, prolonged QRS, and drug-refractory moderate to severe CHF. The growing application of CRT has created a large number of patients with complicated devices that need follow-up care from general practitioners, cardiologists, heart failure specialists and electro-physiologists. Optimal care of the CRT patient includes recognition and management of peri-implantation complications, optimal programming of atrio-ventricular and sequential ventricular timing, and troubleshooting device-related problems during long-term follow-up. A basic awareness of fundamental device features, the techniques to maximize the response to CRT, and an understanding of stored device data to track the response to therapy provide clinicians the ability to maximize clinical outcomes in the CHF patient. As evolving technology continues to increase the complexity of device therapies, clinicians must understand these therapies in order to properly treat heart failure patients. This work summarizes many of the issues involving early complications of CRT device implant, the strategies to optimize device function, and suggests a scheme for follow-up care of patients with CRT devices.