Indications for cardiac resynchronization therapy: 2011 update from the Heart Failure Society of America guideline committee

William G. Stevenson, Adrian F. Hernandez, Peter E. Carson, James C. Fang, Stuart D. Katz, John A. Spertus, Nancy K. Sweitzer, W. H.Wilson Tang, Nancy M. Albert, Javed Butler, Cheryl A. Westlake Canary, Sean P. Collins, Monica Colvin-Adams, Justin A. Ezekowitz, Michael M. Givertz, Ray E. Hershberger, Joseph G. Rogers, John R. Teerlink, Mary N. Walsh, Wendy Gattis StoughRandall C. Starling

Research output: Contribution to journalReview articlepeer-review

85 Scopus citations

Abstract

Cardiac resynchronization therapy (CRT) improves survival, symptoms, quality of life, exercise capacity, and cardiac structure and function in patients with New York Heart Association (NYHA) functional class II or ambulatory class IV heart failure (HF) with wide QRS complex. The totality of evidence supports the use of CRT in patients with less severe HF symptoms. CRT is recommended for patients in sinus rhythm with a widened QRS interval (≥150 ms) not due to right bundle branch block (RBBB) who have severe left ventricular (LV) systolic dysfunction and persistent NYHA functional class II-III symptoms despite optimal medical therapy (strength of evidence A). CRT may be considered for several other patient groups for whom evidence of benefit is clinically significant but less substantial, including patients with a QRS interval of ≥120 to <150 ms and severe LV systolic dysfunction who have persistent mild to severe HF despite optimal medical therapy (strength of evidence B), some patients with atrial fibrillation, and some with ambulatory class IV HF. Several evidence gaps remain that need to be addressed, including the ideal threshold for QRS duration, QRS morphology, lead placement, degree of myocardial scarring, and the modality for evaluating dyssynchrony. Recommendations will evolve over time as additional data emerge from completed and ongoing clinical trials.

Original languageEnglish (US)
Pages (from-to)94-106
Number of pages13
JournalJournal of cardiac failure
Volume18
Issue number2
DOIs
StatePublished - Feb 1 2012
Externally publishedYes

Keywords

  • Heart failure
  • cardiac resynchronization therapy
  • guidelines

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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