Cor Vasa 2011, 53(6-7):360-364 | DOI: 10.33678/cor.2011.088

Lack of effect of cardiac resynchronization therapy in some patients - still unresolved problem

Miloš Táborský^*, Vlastimil Doupal

1. interní klinika - kardiologická, Fakultní nemocnice Olomouc a Lékařská fakulta Univerzity Palackého, Olomouc, Česká republika

A variable percentage of patients with advanced heart failure and ventricular dyssynchrony treated with cardiac resynchronization therapy (CRT) do not benefit from this treatment (the so called non-responders). Efforts to select more eligible patients to maximize the use of human and financial resources have not been very successful. It may be better to define non-responders using a combination of several criteria, such as certain echocardiographic parameters, etiology of the underlying disease, detection of the size and location of the scar by magnetic resonance imaging and late enhancement, and many others, than setting a "universal" cut-off value. More accurate results may also be obtained using a simple clinical score, more accurately predicting individual patients' response to CRT in everyday practice as early as at the time of its indication. Despite the intensive use of sophisticated methods for myocardial imaging to ensure better outcomes for patients, current ways of measuring mechanical and electrical dyssynchrony seem to have their technical limits and are characterized by difficult interpretation of results, and high intra- and interindividual variability. Another barrier to left ventricular pacing site is the anatomy of the cardiac venous system which is very variable and thus prevents the lead being implanted in the optimal left ventricular segment in some cases.

Keywords: Cardiac resynchronization therapy; Heart failure; Implantable cardioverter-defibrillator (ICD); Morbidity; Mortality

Published: June 1, 2011  Show citation