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(Circulation. 2007;115:2208-2220.)
© 2007 American Heart Association, Inc.

Interventional Cardiac Electrophysiology

Interventional Electrophysiology and Cardiac Resynchronization Therapy

Delivering Electrical Therapies for Heart Failure

J. David Burkhardt, MD; Bruce L. Wilkoff, MD

From the Department of Cardiovascular Medicine and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.

Correspondence to J. David Burkhardt, MD, Cardiac Pacing and Tachyarrhythmia Devices, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Ave, Desk F15, Cleveland, OH 44195. E-mail burkhaj1{at}ccf.org

Implantable devices have become a readily available option for patients with heart failure. Not only do these patients develop bradycardia and ventricular tachycardia, but their ventricular dysfunction can often improve with cardiac resynchronization therapy. However, this is a complex and rapidly developing clinical science for which the physician chooses techniques and selects patients on the basis of the results of clinical trials, clinical experience, and rapidly evolving tools. The results depend on the interplay of these complex variables. Placement of the left ventricular lead has forced the device physician to develop new skills and/or interdisciplinary relationships with physicians with vascular intervention, imaging, and surgical skills. Familiarity with the cardiac venous anatomy, occlusive venography, venoplasty, guide wire tools, guiding catheters, stenting, and new intracardiac visualization and magnetic intracardiac lead positioning tools are examples of just a few of the novel skills that are useful in the delivery of cardiac resynchronization therapy. Beyond implantation, these patients and devices require specialized follow-up with continued medical therapy and echo-guided adjustments of device programming. Finally, there are ongoing controversies and many as yet unanswered questions that are the subject of ongoing and planned clinical trials.

Key Words: electrical stimulation • heart failure • pacemakers • defibrillators, implantable