# Cardiac Resynchronization Therapy: Reconsidering Its Essence as a Treatment for Electrical Dyssynchrony in Heart Failure

## TL;DR

This paper discusses how cardiac resynchronization therapy (CRT) is crucial for treating heart failure by correcting electrical dyssynchrony and should be part of a broader treatment strategy.

## Contribution

The paper emphasizes CRT's role in preventing irreversible heart damage and optimizing medical therapy through early intervention.

## Key findings

- CRT improves electrical synchrony in heart failure patients with dyssynchrony.
- Early CRT implantation prevents irreversible cardiac remodeling.
- CRT should be integrated into a comprehensive heart failure management strategy.

## Abstract

Cardiac resynchronization therapy (CRT) essentially targets electrical dyssynchrony, one of the key drivers in heart failure (HF). Its efficacy depends on both the quality (QRS morphology) and quantity (QRS duration) of dyssynchrony, requiring individualized patient selection. While drug therapy for HF has a limited effect on this substrate, early implantation of CRT can prevent irreversible remodeling and facilitate optimization of medical therapy. CRT should be recognized as an essential component within a comprehensive strategy for HF management in patients with appropriate indications.

Flow of cardiac resynchronization therapy (CRT) in heart failure management. Heart failure (HF) patients with electrical dyssynchrony are first identified through screening. If electrical dyssynchrony contributes to HF deterioration, CRT is initiated to improve electrical synchrony. CRT elevates the “cardiac synchrony” component, leading to stabilization of the HF condition. When HF subsequently worsens, the electrocardiogram (ECG) is evaluated. If the ECG shows no change compared with the post‐CRT pattern of improved electrical synchrony, interventions targeting other drivers of HF are performed. If the ECG demonstrates changes indicating loss of the previously improved electrical synchrony, CRT reprogramming or multi‐site pacing strategy should be undertaken.