Heart failure has a high prevalence and it has a poor prognosis
despite the advances in pharmacological treatment. Cardiac
resynchronization therapy with biventricular pacemaker has a
clinically proven efficacy in the treatment of heart failure
with intraventricular dyssynchrony. Conventionally the therapy
is indicated in severe drug refractory heart failure (NYHA III-
IV) with optimal drug treatment, increased QRS duration (> or =
120 ms), echocardiographic parameters (left ventricular ejection
fraction at most 35%). Implementation of new methods (tissue
doppler echocardiography, CT, MRI, electroanatomical mapping)
can help to select potentially responding patients. Individual
optimization of therapy can be performed with non-invasive and
invasive methods, the efficacy can be improved even in
responding patients. Due to the outstanding efficiency widening
the indications is a must. Currently, the efficacy is being
investigated in mild heart failure and patients with narrow QRS.
Several other questions (transvenous or surgical implantation,
need of an implantable defibrillator) will be answered in
future trials.
