Cardiac Resynchronization Therapy for Heart Failure.

Cardiac resynchronization therapy has been established as important adjuvant therapy in the treatment of severe heart failure. As lead delivery systems have improved and the number of experienced implanters has increased, more patients have access to transvenous left ventricular lead implantation, outside of clinical trials at large medical centers. Ongoing research continues to perfect implantation techniques to optimize patient outcomes, as well as develop hardware and software technology used in implanted devices. Resynchronization therapy typically results in a decreased burden of emergency room visits and hospitalizations for decompensated heart failure. In addition, diagnostic tools available in resynchronization devices allow clinicians to not only predict heart failure decompensation and adjust medical therapies accordingly, but they also allow for the diagnosis of asymptomatic arrhythmias that may predict adverse outcomes, as well as allow for the diagnosis of symptomatic arrhythmias without the need for additional costly workup. This suggests that in the long term, biventricular device implantation may actually provide cost savings to the health care system. On a macroeconomic scale, there are significant concerns about the cost burden to society of increased implantation of resynchronization therapy devices, along the same lines as concerns raised regarding the expanding indications for implantable cardioverter-defibrillator implantation. As future research broadens indications for implanting implantable cardioverter-defibrillators, as well as resynchronization systems, we may see cardiac resynchronization therapy become a secondary prevention tool yielding long-term patient benefits by postponing or preventing a decline in heart failure status.