Pacing and heart failure: should all patients receive a biventricular device?

The increasing adoption of biventricular pacing as a means to achieve interventricular, intraventricular, and atrioventricular synchronization affords clinicians a powerful nonpharmacologic tool in the treatment of congestive heart failure. Current guidelines support the use of cardiac resynchronization therapy (CRT) in patients with the combination of severe systolic ventricular dysfunction, symptomatic heart failure, and evidence of conduction delay on the surface electrocardiogram. Current research aims include investigation of differing clinical parameters and imaging techniques that will reliably differentiate patients who may or may not benefit from CRT. Furthermore, refinements in the techniques of lead placement and intrachamber timing may further improve the proportion of patients who achieve a favorable response from CRT. This article briefly reviews the history of CRT and summarizes some of the current trends and data relating to CRT.