Clinical Review

Cardiac resynchronisation therapy for chronic heart failure and conduction delay

BMJ 2009; 338 doi: (Published 28 April 2009) Cite this as: BMJ 2009;338:b1265
  1. Richard M Cubbon, lecturer in cardiology1,
  2. Klaus K A Witte, senior lecturer in cardiology and honorary consultant cardiologist1
  1. 1Division of Cardiovascular and Diabetes Research, University of Leeds, Leeds LS2 9JT
  1. Correspondence to: K K A Witte klauswitte{at}

    Summary points

    • Consider cardiac resynchronisation therapy for any patient with chronic heart failure if they have, or have recently had, moderate or severe symptoms of heart failure; if their left ventricular ejection fraction is ≤35%; and if their QRS duration is ≥150 ms or 120-149 ms with dyssynchrony measured on echocardiography

    • Cardiac resynchronisation therapy can improve symptoms and prognosis

    • Advanced age does not reduce the effectiveness of the therapy

    • All healthcare professionals involved in the management of heart failure need to be aware of the potential benefits of cardiac resynchronisation therapy and who to refer

    • Evaluation of the QRS duration and heart rhythm on the electrocardiogram should be part of the standard management of any patient with heart failure and repeated at least yearly

    Chronic heart failure is common, affecting about 900 000 people in the United Kingdom and with a prevalence of about 6-10% in people aged over 65 years1; despite modern drug treatment, it carries a high morbidity and a 10% annual mortality. About a third of patients with chronic heart failure have a left ventricular ejection fraction ≤35%,2 up to 40% of whom are at risk of worse outcomes and more severe heart failure identified by conduction delay (QRS duration on a surface electrocardiogram of >120 ms).3

    A recent addition to therapeutic algorithms for chronic heart failure is cardiac resynchronisation therapy (also known as biventricular pacing). Cardiac resynchronisation therapy is a well proved treatment for patients with heart failure who have left ventricular systolic dysfunction and conduction delay, and it can reduce symptoms and admission to hospital and improve quality of life and prognosis. Clear mortality benefits have moved it from a treatment for intractable symptoms to one that, alongside β blockers, angiotensin converting enzyme inhibitors, and aldosterone antagonists, is now a routine therapy for patients …

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