A Critical Reappraisal of the Current Clinical Indications to Cardiac Resynchronisation Therapy
Antonio Sorgente1, Riccardo Cappato1
1Arrhythmia and Electrophysiology Department, Policlinico San Donato, Milan, Italy.
Insights
Cardiac resynchronization therapy (CRT) improves heart failure (HF) outcomes. This review examines CRT
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) is a standard treatment for symptomatic heart failure (HF) patients with conduction delays.
- Left bundle branch block (LBBB) significantly impairs cardiac performance in HF, making CRT a potential intervention.
- Current guidelines expand CRT indications despite a notable non-response rate.
Purpose of the Study:
- To critically evaluate the clinical evidence supporting current CRT indications.
- To identify potential issues and challenges associated with CRT.
- To propose future research directions aimed at reducing CRT non-response.
Main Methods:
- Review of existing clinical evidence and guidelines on CRT.
- Analysis of factors contributing to CRT non-response in heart failure.
- Identification of research gaps in optimizing CRT efficacy.
Main Results:
- CRT is indicated for symptomatic HF, particularly with LBBB, but non-response remains a concern.
- Expanding CRT indications may increase the number of non-responders without clear guidance on mitigation.
- Evidence supporting current CRT indications requires reappraisal.
Conclusions:
- Further research is needed to refine patient selection and improve CRT response rates.
- A critical review of CRT efficacy is essential to optimize patient outcomes.
- Future studies should focus on reducing the percentage of non-responders to CRT.
Abstract:
Cardiac resynchronisation therapy (CRT) is a well-established non-pharmacological treatment option for patients with refractory symptomatic heart failure (HF) already under optimal medical therapy. CRT is founded on the principle that interventricular conduction disturbances and more in particular left bundle branch block (LBBB) are deleterious to cardiac performance, and may contribute to the systolic and diastolic incompetency typical of patients with HF. Although CRT is associated with a not negligible percentage of non-response, all the international guidelines on chronic HF have extended their indications to CRT, also to patients with less symptomatic HF who are already showing signs of systolic dysfunction and interventricular dyssynchrony, without giving any substantial advice to reduce the number of failures of this therapy. This review seeks to point out the potential issues linked to CRT, with the aim of making a reappraisal of the clinical evidences supporting the current indications to CRT, and to figure out which type of research should be warranted in the field for the future to reduce the percentage of non-responders to this therapy.
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