Cardiac resynchronization therapy: a practical guide for patient management after device implantation, part II

This is the second of a two-part series on strategies for optimizing the delivery of cardiac resynchronization therapy (CRT). A previous article presented strategies to optimize CRT device functioning. This article focuses on patient-related aspects. The 2005 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for Managing Adults with Chronic Heart Failure now designate CRT as a class IA recommendation for stage C patients (QRS duration, > or = 120 milliseconds; left ventricular ejection fraction, < or = 35%) who remain symptomatic despite optimal medical therapy. While the evidence from prospective randomized controlled trials demonstrates consistent and concordant support for CRT in patients with symptomatic heart failure and ventricular dyssynchrony, a substantial minority of patients do not experience clinical improvement from CRT. In addition to device optimization, optimizing individual patient responses is essential. This article discusses measures for enhancing the patient's response to a CRT device.