Inclusion and exclusion criteria for CRT

Patients with nonischemic cardiomyopathy requiring cardiac resynchronization therapy should also undergo implantation of a primary prevention defibrillator: the con perspective

This article describes a 45-year-old lady with longstanding dilated cardiomyopathy, who has progressed to New York Heart Association class III and has failed to respond to optimal pharmacologic therapy. On the basis of gender and the presence of an left bundle branch block, she has good prospects of responding to cardiac resynchronization therapy. In the background of nonischemic cardiomyopathy and the absence of myocardial scarring on cardiovascular magnetic resonance, her annualized risk of sudden cardiac death is low, estimated at 2.6%.

Cardiac resynchronization therapy guided by cardiovascular magnetic resonance

Cardiac resynchronization therapy (CRT) is an established treatment for patients with symptomatic heart failure, severely impaired left ventricular (LV) systolic dysfunction and a wide (> 120 ms) complex. As with any other treatment, the response to CRT is variable. The degree of pre-implant mechanical dyssynchrony, scar burden and scar localization to the vicinity of the LV pacing stimulus are known to influence response and outcome. In addition to its recognized role in the assessment of LV structure and function as well as myocardial scar, cardiovascular magnetic resonance (CMR) can be used to quantify global and regional LV dyssynchrony. This review focuses on the role of CMR in the assessment of patients undergoing CRT, with emphasis on risk stratification and LV lead deployment.