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(Circulation. 2006;114:2692-2698.)
© 2006 American Heart Association, Inc.

Controversies in Cardiovascular Medicine

Cardiac Resynchronization Therapy Is Important for All Patients With Congestive Heart Failure and Ventricular Dyssynchrony

William T. Abraham, MD

From the Department Internal Medicine, Division of Cardiovascular Medicine, the Department of Physiology and Cell Biology, and the Davis Heart and Lung Research Institute, Ohio State University, Columbus.

Correspondence to William T. Abraham, MD, Ohio State University Heart Center, Division of Cardiovascular Medicine, 473 W 12th Ave, Room 110P DHLRI, Columbus, OH 43210–1252. E-mail William.Abraham@osumc.edu

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

	Introduction

 
More than 4000 patients have been evaluated in randomized controlled trials of cardiac resynchronization therapy (CRT). These studies have demonstrated that CRT with or without an implantable cardioverter-defibrillator (ICD) consistently improves quality of life, functional status, exercise capacity, and cardiac structure and function and reduces morbidity and mortality in heart failure patients with ventricular dyssynchrony. The magnitude of benefit seen with CRT is comparable to or exceeds that seen with evidence-based drug therapies for heart failure but occurs in patients who are already receiving such medications. Thus, CRT has been added to the list of evidence-based therapies that make heart failure patients feel better and live longer (the Table). Consequently, a strong ethical mandate exists for the use of CRT in heart failure. This mandate is reflected in our current practice guidelines for the management of chronic heart failure, which state that all eligible patients should receive CRT unless contraindicated.^1,2 End of debate! CRT should be a routine part of any evidence-based treatment regimen for heart failure.

View this table:   Major Benefits of Evidence-Based Heart Failure Therapies

Of course, things are never quite so simple, so let us take a look at the evidence supporting this clinical mandate for CRT and address patient selection, some of the limitations of CRT, and some of the unanswered questions about the use of CRT in heart failure. None of this discussion will lessen the role of CRT in the treatment of heart failure; rather, it will guide the selection of appropriate patients and speculate on . . . [Full Text of this Article]

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