Cardiac resynchronization therapy for CHF. The rewards and risks of biventricular pacing.

Patients with advanced heart failure continue to experience high morbidity and mortality despite recent progress made with the use of such drugs as beta-blockers and angiotensin-aldosterone inhibitors. Cardiac transplantation has severe limitations due to the short supply of organs and the ineligibility of most CHF patients for this therapy. Approved heart-assist devices are cumbersome and costly. Therefore, these devices are currently used mainly in tertiary care centers in a limited number of patients. CRT has been rapidly evolving as a viable and beneficial therapy that is universally applicable by percutaneous method in patients with moderate or severe heart failure. Its relative ease of use and cost-effectiveness make it an attractive option for patients with symptomatic heart failure. Therefore, more physicians are becoming aware of the low threshold for its use.