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(Circulation. 2006;113:926-928.)
© 2006 American Heart Association, Inc.

Editorial

Quest for the Best Candidate

How Much Imaging Do We Need Before Prescribing Cardiac Resynchronization Therapy?

Ole-Alexander Breithardt, MD; Günter Breithardt, MD

From I. Medizinische Klinik, Klinikum Mannheim gGmbH, Faculty of Clinical Medicine Mannheim at the University of Heidelberg, Mannheim, Germany (O.-A.B.); and Medizinische Klinik und Poliklinik C, Westfälische-Wilhelms-Universität Münster, Münster, Germany (G.B.).

Correspondence to Priv-Doz Dr med Ole-A. Breithardt, I. Medizinische Klinik, Klinikum Mannheim gGmbH, Theodor-Kutzer-Ufer 1–3, D-68167 Mannheim, Germany. E-mail ole.breithardt@med.ma.uni-heidelberg.de

Key Words: Editorials • echocardiography • heart failure • magnetic resonance imaging • pacing

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Within the last decade, cardiac resynchronization therapy (CRT) has evolved rapidly and is today widely accepted as a class I indication for selected patients with heart failure.^1,2 It is generally recommended for patients with advanced systolic heart failure who are symptomatic despite optimized pharmacological treatment and who show evidence of ventricular dyssynchrony, usually diagnosed by a prolongation of the QRS width above 120 to 130 ms. Devices that combine biventricular pacing with an implantable defibrillator (CRT-D) have demonstrated a significant reduction in arrhythmic death in a high-risk population.^3,4 The more recently published results from the Cardiac Resynchronization-Heart Failure (CARE-HF) trial showed a significant survival benefit for such selected patients who were treated with a biventricular CRT pacemaker device (CRT-P) without defibrillator backup.⁵ These beneficial CRT effects in addition to optimized pharmacological therapy result in a strikingly reduced need for heart failure–related hospitalization and make CRT-P clearly a cost-effective therapy, with an incremental cost-effectiveness ratio of less than &$25.000 per quality-adjusted life-year gained.^6–8 At present, however, the majority of implanted systems in the United States and in Western Europe are CRT-D devices, which, in comparison to CRT-P, offer only a comparatively modest additional survival benefit in relation to their incremental costs.⁹ Therefore, these CRT-D devices must currently be regarded as less cost-effective than CRT-P, and there is an ongoing debate as to whether every patient qualifying for CRT should receive a CRT-D device.^10,11 From a cardiologist’s point of view, the decision about the need for a defibrillator backup should only be . . . [Full Text of this Article]

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