Cardiac Resynchronization Therapy in Heart Failure Management
Summary
Cardiac resynchronization therapy (CRT) has emerged as a cornerstone in the management of selected patients with chronic heart failure characterised by reduced left ventricular ejection fraction and evidence of ventricular dyssynchrony, most commonly reflected by a widened QRS complex and left bundle branch block. By delivering synchronous electrical stimulation to both right and left ventricles, CRT restores coordinated contraction, promotes reverse remodelling, alleviates symptoms and reduces hospital admissions and mortality. Despite robust guideline support, approximately one-third of recipients derive limited benefit, often owing to suboptimal lead placement, myocardial scarring or persistent conduction delays. Advances in multipolar leads, imaging guidance and device programming have sought to address these challenges. Furthermore, novel pacing strategies such as His bundle pacing and left bundle branch area pacing aim to engage the native conduction system, offering physiological activation patterns. Optimal patient selection, scar characterisation by cardiovascular magnetic resonance and ongoing refinement of implantation techniques remain central to maximising response and extending the global impact of CRT in heart failure care.
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Cardiac Resynchronization Therapy in Heart Failure Management publication trend
The graph below shows the total number of articles in cardiac resynchronization therapy in heart failure management across all publications each year (not limited to Nature Index journals).
Technical terms
Cardiac resynchronisation therapy (CRT): Delivery of timed electrical impulses to both ventricles to re-coordinate mechanical contraction in heart failure with electrical dyssynchrony.
Biventricular pacing: Conventional CRT technique involving leads in the right ventricle and via the coronary sinus to the left ventricular epicardium.
His bundle pacing: A physiological pacing modality that captures the native His‐Purkinje system to achieve uniform ventricular activation.
Left bundle branch block (LBBB): Intrinsic conduction delay characterised by late activation of the left ventricle, often indicating CRT candidacy.
Late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR): Imaging technique that identifies myocardial scar to guide optimal left ventricular lead deployment.
References
- Effects of haemodynamically atrio‐ventricular optimized His bundle pacing on heart failure symptoms and exercise capacity: the His Optimized Pacing Evaluated for Heart Failure (HOPE‐HF) randomized, double‐blind, cross‐over trial. European Journal of Heart Failure (2023).
- Cardiac resynchronization therapy guided by late gadolinium-enhancement cardiovascular magnetic resonance. Journal of Cardiovascular Magnetic Resonance (2011).
- Understanding non-response to cardiac resynchronisation therapy: common problems and potential solutions. Heart Failure Reviews (2018).
- Cardiac Resynchronization Therapy Delivered Via a Multipolar Left Ventricular Lead is Associated with Reduced Mortality and Elimination of Phrenic Nerve Stimulation: Long‐Term Follow‐Up from a Multicenter Registry. Journal of Cardiovascular Electrophysiology (2015).
- Immediate clinical outcomes of left bundle branch area pacing vs conventional right ventricular pacing. Clinical Cardiology (2019).
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