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European Heart Journal Advance Access originally published online on August 28, 2008
European Heart Journal 2008 29(20):2458-2472; doi:10.1093/eurheartj/ehn380
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

How should we optimize cardiac resynchronization therapy?

Tony Stanton1,*, Nathaniel M. Hawkins2, Kerry J. Hogg3, Nicholas E.R. Goodfield3, Mark C. Petrie4 and John J.V. McMurray5

1 Department of Medicine, University of Queensland Princess Alexandra Hospital, Ipswich Road, Brisbane Q4102, Australia
2 University Hospital Aintree, Liverpool, UK
3 Stobhill Hospital, Glasgow, UK
4 Golden Jubilee National Hospital, Glasgow, UK
5 Western Infirmary, Glasgow, UK

Received 26 November 2008; revised 26 June 2008; accepted 25 July 2008; online publish-ahead-of-print 28 August 2008.

* Corresponding author. Tel: +61 732407857, Fax: +61 732405399, Email: t.stanton{at}uq.edu.au

Optimization of cardiac resynchronization therapy is increasingly performed. Numerous methods have been proposed, many being echocardiographic. Both the technique and the timing of optimization are contentious. Whether acute haemodynamic benefits translate into long-term improvements in remodelling, symptoms, or prognosis is unknown. Recent guidelines from the American Society of Echocardiography advocate routine optimization. Here, we objectively review the principles, methods, timing, and evidence supporting optimization. Despite limited validation, optimization was included in landmark clinical trials and is inherent in evidence-based practice. Randomized controlled trials comparing methods are needed, with long-term clinical endpoints. For now, optimization should be performed using the iterative method, according to the CARE-HF protocol.

Key Words: Optimization • Cardiac resynchronization therapy • Atrioventricular delay • Interventricular delay


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