title: Periprocedural management of cardiac resynchronization therapy.
abstract: Cardiac resynchronization therapy (CRT) is an important therapy in heart failure but 30 %‒40 % of patients may not respond. Improving this rate is an important goal and requires attention to candidate selection, intraoperative procedure, and postoperative follow-up. Factors to be considered are QRS morphology, duration, and left ventricular lead position with attention to paced effects on QRS. Postprocedure follow-up is critical to correct interfering conditions (eg, anodal capture, loss of 100 % biventricular pacing because of premature ventricular complexes (PVCs) or atrial fibrillation (AF). Echocardiographic improvement following CRT, which may take up to 18 months, is a potent predictor of long-term outcomes. Correcting the status of nonresponders, when possible, is important. Remote monitoring, in conjunction with CRT optimization clinics, may facilitate multidisciplinary follow-up and enable early intervention to improve outcome.
authors.affiliation: Division of Cardiology, The Johns Hopkins Hospital, Baltimore, USA.
authors.forename: John
authors.initials: J
authors.lastname: Rickard
authors.forename: Niraj
authors.initials: N
authors.lastname: Varma