ATS February 2009:  Hansky, Bert, et al.  Cardiac Resynchronization Therapy: Long-Term Alternative to Cardiac Transplantation?  Ann Thorac Surg 87:432-438.

In the February 2009 Annals, Hansky et al discuss the implications of CRS in patients awaiting cardiac transplantation.  They note that although cardiac transplantation remains the gold standard for end stage heart failure alternatives are needed. They investigated the impact of CRS on clinical outcome in 545 patients with left bundle-branch block and interventricular asynchrony, who fulfilled the cardiac criteria for cardiac transplantation listing. Their primary end point was heart failure related death. Secondary endpoints were NYHA class, and functional (cardiopulmonary exercise tolerance,6-minute hall walk distance), and functional-morphologic factors.  In this report, average follow-up period was39.6 months. The percentage of nonresponders (no functional and morphologic improvement during follow-up) was 21.2%. One-year and 3-year freedom from heart failure death was 92.3% and 77.3%, respectively. Interestingly, under cardiac resynchronization therapy, 42.5% of the transplant  candidates with atrial fibrillation at baseline returned to sinus rhythm. The authors concluded that cardiac resynchronization therapy is a reliable long-term therapeutic option for the treatment of end-stage heart failure with intraventricular asynchrony. This important report emphasizes the usefulness of a readily available and relatively uncomplicated form of therapy in a very difficult group of patients. 

Please read the article at http://ats.ctsnetjournals.org/cgi/content/full/87/2/432 and add your own comments and experience in the Dilemmas in Adult CardiacSurgery discussion forum.