Cardiac resynchronization therapy (CRT) nonresponders in the contemporary era: A state-of-the-art review

In the 2000s, cardiac resynchronization therapy (CRT) became a revolutionary treatment for heart failure with reduced left ventricular ejection fraction (HFrEF) and wide QRS. However, about one-third of CRT recipients do not show a favorable response. This review of the current literature aims to be...

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Bibliographic Details
Published in:Heart rhythm Vol. 22; no. 1; p. 159
Main Authors: Gerra, Luigi, Bonini, Niccolò, Mei, Davide Antonio, Imberti, Jacopo Francesco, Vitolo, Marco, Bucci, Tommaso, Boriani, Giuseppe, Lip, Gregory Y H
Format: Journal Article
Language:English
Published: United States 01.01.2025
Subjects:
Cardiac Resynchronization Therapy - methods
Heart Failure - physiopathology
Heart Failure - therapy
Humans
Stroke Volume - physiology
Treatment Outcome
Heart failure
Cardiac resynchronization therapy
Nonresponders
Conduction system pacing
Left bundle branch area pacing
ISSN:1556-3871, 1556-3871
Online Access:Get more information
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Summary:In the 2000s, cardiac resynchronization therapy (CRT) became a revolutionary treatment for heart failure with reduced left ventricular ejection fraction (HFrEF) and wide QRS. However, about one-third of CRT recipients do not show a favorable response. This review of the current literature aims to better define the concept of CRT response/nonresponse. The diagnosis of CRT nonresponder should be viewed as a continuum, and it cannot rely solely on a single parameter. Moreover, baseline features of some patients might predict an unfavorable response. A strong collaboration between heart failure specialists and electrophysiologists is key to overcoming this challenge with multiple strategies. In the contemporary era, new pacing modalities, such as His-bundle pacing and left bundle branch area pacing, represent a promising alternative to CRT. Observational studies have demonstrated their potential; however, several limitations should be addressed. Large randomized controlled trials are needed to prove their efficacy in HFrEF with electromechanical dyssynchrony.
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ISSN:1556-3871
1556-3871
DOI:10.1016/j.hrthm.2024.05.057