Cardiac resynchronization therapy: predictors of failure and strategies to overcome

Evaluation of: Macias A, Garcia-Bolao I, Diaz-Infante E et al. Cardiac resynchronization therapy: predictive factors of unsuccessful left ventricular lead implant. Eur. Heart J. 28, 450–456 (2007).Congestive heart failure (CHF) is a leading cause of morbidity, mortality and hospitalization in the elderly of industrialized nations. In CHF patients with moderate-to-severe left ventricular systolic dysfunction and significant dyssynchrony, cardiac resynchronization therapy (CRT) has been shown to improve functional status and decrease heart failure mortality and hospitalizations. Inability to transvenously implant a lead within a desired branch of the coronary sinus for CRT occurs in 5–10% of cases. The article under evaluation identifies two independent predictors of failed transvenous left ventricular lead implantation – the presence of permanent atrial fibrillation and an increased anteroposterior left atrial diameter.