Advanced therapies: Cardiac resynchronization therapy for heart failure

Cardiac resynchronization therapy (CRT) refers to the application of multisite ventricular pacing with the goal of normalizing left and right ventricular timing (i.e., resynchronizing) that has been disturbed by heart disease. Current CRT methods are imperfect, but they do represent a major advance in managing systolic heart failure (HF). As an "advanced" therapy, CRT offers the advantages of both being widely available (as opposed to, e.g., ventricular assist devices or heart transplantation) and having abundant data supporting its clinical utility (as opposed to, e.g., the current state of stem cell therapy). Further, to the extent that CRT improves inotropy, it is unique in that, unlike pharmacologic inotropic agents such as dobutamine [1] or milrinone [2], it does not increase-and may decrease-mortality.