Cardiac Resynchronization Therapy: An Overview on Guidelines
Giuseppe Boriani1, Martina Nesti2, Matteo Ziacchi1
1Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital, Via Giuseppe Massarenti 9, Bologna 40138, Italy.
Insights
Cardiac resynchronization therapy (CRT) is recommended for specific heart conditions based on QRS duration. However, CRT is often underused and inconsistently applied in clinical practice.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Cardiac resynchronization therapy (CRT) is a guideline-recommended treatment for heart failure.
- Optimal patient selection and therapy implementation are crucial for CRT efficacy.
Purpose of the Study:
- To review the current guidelines and evidence regarding CRT.
- To highlight the underutilization and implementation variability of CRT.
Main Methods:
- Review of international consensus guidelines on CRT.
- Analysis of data on CRT recommendations based on QRS duration and LBBB.
- Assessment of factors influencing CRT underuse and heterogeneity.
Main Results:
- Strong recommendation for CRT in LBBB with QRS > 150 ms.
- Weaker recommendations for CRT in QRS 120-150 ms, especially without LBBB.
- No echocardiographic dyssynchrony guidance for CRT implantation.
- Significant underuse and variability in CRT implementation observed.
Conclusions:
- CRT guidelines provide clear indications based on QRS duration.
- Addressing CRT underuse and implementation heterogeneity is essential for improving patient outcomes.
Abstract:
Cardiac resynchronization therapy (CRT) is included in international consensus guidelines as a treatment with proven efficacy in well-selected patients on top of optimal medical therapy. Although all the guidelines strongly recommend CRT for LBBB with QRS duration greater than 150 milliseconds, lower strength of recommendation is reported for QRS duration of 120 to 150 milliseconds, especially if not associated with LBBB. CRT is not recommended for a QRS of less than 120 milliseconds. No indication emerges for guiding the implant based on echocardiographic evaluation of dyssynchrony. Many data indicate that CRT is underused and there is heterogeneity in its implementation.
Related Concept Videos
Heart Failure VI: Adjunct Therapies
Cardiomyopathy II: Dilated Cardiomyopathy
Cardiomyopathy V: Interprofessional Care
Dysrhythmias VI: Management of Dysrhythmias
Cardiopulmonary Resuscitation IV: Pharmacological Management
Cardiomyopathy IV: Restrictive Cardiomyopathy


