title: Cardiac resynchronization therapy: Part 2--issues during and after device implantation and unresolved questions.
abstract: Encouraged by the clinical success of cardiac resynchronization therapy (CRT), the implantation rate has increased exponentially, although several limitations and unresolved issues of CRT have been identified. This review concerns issues that are encountered during implantation of CRT devices, including the role of electroanatomical mapping, whether CRT implantation should be accompanied by simultaneous atrioventricular nodal ablation in patients with atrial fibrillation, procedural complications, and when to consider surgical left ventricular lead positioning. Furthermore, (echocardiographic) CRT optimization and assessment of CRT benefits after implantation are highlighted. Also, controversial issues such as the potential value of CRT in patients with mild heart failure or narrow QRS complex are addressed. Finally, open questions concerning when to combine CRT with implantable cardioverter-defibrillator therapy and the cost-effectiveness of CRT are discussed.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. jbax@knoware.nl
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Theodore
authors.initials: T
authors.lastname: Abraham
authors.forename: S Serge
authors.initials: SS
authors.lastname: Barold
authors.forename: Ole A
authors.initials: OA
authors.lastname: Breithardt
authors.forename: Jeffrey W H
authors.initials: JW
authors.lastname: Fung
authors.forename: Stephane
authors.initials: S
authors.lastname: Garrigue
authors.forename: John
authors.initials: J
authors.lastname: Gorcsan
authors.forename: David L
authors.initials: DL
authors.lastname: Hayes
authors.forename: David A
authors.initials: DA
authors.lastname: Kass
authors.forename: Juhani
authors.initials: J
authors.lastname: Knuuti
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
authors.forename: Cecilia
authors.initials: C
authors.lastname: Linde
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Mark
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Monaghan
authors.forename: Petros
authors.initials: P
authors.lastname: Nihoyannopoulos
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: Christophe
authors.initials: C
authors.lastname: Stellbrink
authors.forename: Cheuk-Man
authors.initials: CM
authors.lastname: Yu
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy; D001283:Atrioventricular Node; D002303:Cardiac Output, Low / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D004452:Echocardiography; D004554:Electric Countershock; D006801:Humans; D007430:Intraoperative Care; D007431:Intraoperative Complications; D010138:Pacemaker, Artificial; D011182:Postoperative Care; D016896:Treatment Outcome