Cardiac resynchronization therapy: overcoming ventricular dyssynchrony in dilated heart failure.

Despite optimal medical therapy, dilated heart failure is associated with a dismal prognosis and relentless progression. Intraventricular conduction delay or bundle branch block is a marker of heart failure progression and worsening prognosis. Patients fitting this profile have been shown to benefit from a specific form of cardiac pacing now referred to as cardiac resynchronization therapy (CRT). This monograph is an in-depth review of the theory and consequences of ventricular dyssynchrony in dilated heart failure, and provides an overview of the major clinical trials of CRT. Practical considerations for achieving ventricular resynchronization are discussed, with an emphasis on biventricular pacing.