title: Non-responders to cardiac resynchronization therapy: Insights from multimodality imaging and electrocardiography. A brief review.
abstract: BACKGROUND
  Cardiac resynchronization therapy (CRT) is a successful strategy for heart failure (HF) patients. The pre-requisite for the response is the evidence of electrical dyssynchrony on the surface electrocardiogram usually as left bundle branch block (LBBB). Non-response to CRT is a significant problem in clinical practice. Patient selection, inadequate delivery and sub-optimal left ventricle lead position may be important causes.
  
  
  OBJECTIVE
  In an effort to improve CRT response multimodality imaging (especially echocardiography, computed tomography and cardiac magnetic resonance) could play a decisive role and extensive literature has been published on the matter. However, we are so far from routinary use in clinical practice. Electrocardiography (with respect to left ventricle capture and QRS narrowing) may represent a simple and low cost approach for early prediction of potential non-responder, with immediate practical implications.
  
  
  CONCLUSIONS
  This brief review covers the current recommendations for CRT in HF patients with particular attention to the potential benefits of multimodality imaging and electrocardiography in improving response rate.
authors: Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy. Electronic address: patcar@hotmail.it.
authors: Patrizia
authors: P
authors: Carità
authors: Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy.
authors: Egle
authors: E
authors: Corrado
authors: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors: Gianluca
authors: G
authors: Pontone
authors: Chair and Unit of Cardiology University of Brescia, Spedali Civili Hospital, Italy.
authors: Antonio
authors: A
authors: Curnis
authors: Chair and Unit of Cardiology University of Brescia, Spedali Civili Hospital, Italy.
authors: Luca
authors: L
authors: Bontempi
authors: Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy.
authors: Giuseppina
authors: G
authors: Novo
authors: Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors: Marco
authors: M
authors: Guglielmo
authors: Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy.
authors: Gianfranco
authors: G
authors: Ciaramitaro
authors: Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy.
authors: Pasquale
authors: P
authors: Assennato
authors: Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy.
authors: Salvatore
authors: S
authors: Novo
authors: Department of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy.
authors: Giuseppe
authors: G
authors: Coppola
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000379:methods* / Q000639:trends; D004562:Electrocardiography / Q000379:methods* / Q000639:trends; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D064847:Multimodal Imaging / Q000379:methods* / Q000639:trends; D016896:Treatment Outcome
keywords: Cardiac resynchonization therapy; Electrocardiography; Heart failure; Multimodality imaging; Response