Cardiac Resynchronization Therapy

State of the Art 2013

Cheuk-Man Yu; David L. Hayes


Eur Heart J. 2013;34(19):1396-1403. 

In This Article

Non-responders of Cardiac Resynchronization Therapy

About one-third of patients currently do not respond to CRT clinically based on the current guideline, and more than 40% do not show LV reverse remodelling response. However, some patients might potentially be responders if managed properly.[32] Figure 2 suggested the algorithm of managing CRT non-responders. Although echocardiographic assessment of dyssynchrony has been shown to predict CRT response in studies preformed in experienced center, it was unable to be replicated in multicenter trials. This complex issue has been discussed elsewhere recently.[52] However, dyssynchrony assessment remains helpful in illustrating the mechanisms of CRT benefit, potentially in assisting patient selection in those who have a narrow QRS complex with mechanical dyssynchrony, as well as guiding the placement of LV lead. Figure 3 summarizes the commonly used parameters of dyssynchrony assessment and their cut-off values.

Figure 2.

Clinical approach to cardiac resynchronization therapy non-responder.

Figure 3.

Commonly used systolic dyssynchrony indices and their reported cutoff values. (A) Intraventricular dyssynchrony, short-axis dyssynchrony. (B) Intraventricular dyssynchrony, long-axis dyssynchrony. (C) Interventricular dyssynchrony.