Abstract
Résumé
Preimplant Assessment and Procedural Preparation
Patient selection
Functional assessment
- Arena R.
- Myers J.
- Williams M.A.
- et al.
Practical tip
Patient factors and comorbidities
Factors to consider | Recommended | For consideration |
---|---|---|
Patient selection | NYHA II, III, or ambulatory IV, HF, LVEF ≤ 35%, QRS ≥ 130 ms if LBBB; sinus rhythm, and the absence of severe CKD (creatinine < 200 mmol/L or GFR > 30 mL/min/m2) | QRS > 150 ms if non-LBBB; presence of AF; elderly age; evidence of frailty; chronic RV pacing with LVEF ≤ 45% |
Imaging | Evaluation of LVEF: echocardiogram, nuclear imaging, cardiac magnetic resonance | Imaging for assistance in LV lead placement |
Anticoagulation | Continue warfarin if high risk for thromboembolism | Novel oral anticoagulants will need to be considered on an individual basis (see text) |
Renal insufficiency | Adequate hydration; hold or decrease diuretics |
Age
Renal function
Etiology of LV dysfunction
Frailty
- 1.We recommend that the prescription of CRT and the choice of platform (CRT-P vs CRT-D) should take into account clinical factors that would affect the overall goals of care (Strong Recommendation, Moderate-Quality Evidence).
De novo onset of pacemaker dependence
- 2.We suggest that CRT might be considered for patients with new-onset high-degree AV block requiring chronic RV pacing, signs and/or symptoms of HF, and LVEF ≤ 45% (Conditional Recommendation, Moderate-Quality Evidence).
Consideration for upgrade to CRT
- 3.We recommend that all patients with HF who are planned to receive a CIED system revision should be considered for their eligibility for upgrade to CRT (Strong Recommendation, Low-Quality Evidence).

Patients undergoing open heart surgery
- 4.We suggest that placement of an LV lead at the time of open heart surgery, for the purpose of facilitating future CRT, might be considered in patients for whom CRT is recommended and the need for device therapy is unlikely to be changed by the surgical procedure (Conditional Recommendation, Low-Quality Evidence).
Use of antithrombotic agents periprocedurally
- 5.We recommend that in patients taking warfarin for whom perioperative anticoagulation is deemed necessary, continued warfarin is recommended over the use of heparin-based bridging (Strong Recommendation, Moderate-Quality Evidence).
Operative Issues
General principles
- 6.We recommend that CRT implantation be performed only in facilities that have strict infection prevention control standards (Strong Recommendation, Low-Quality Evidence).
Radiation safety
- Calkins H.
- Brugada J.
- Packer D.L.
- et al.
- 7.We recommend that appropriate fluoroscopic equipment, radiation shielding, and radiation reduction imaging methods be used to minimize radiation exposure to the operator, patient, and other staff (Strong Recommendation, Low-Quality Evidence).
Avoidance of complications
Complication | Incidence | Suggested methods to prevent |
---|---|---|
Contrast-induced nephropathy | 7%-43% | Prehydration; lower dose of diuretics; lower dose of contrast, dilution of contrast 46 |
Pneumothorax | 0.6%-1.0% | Extrathoracic puncture, echo-guided or contrast-guided venous puncture, axillary is preferred to subclavian; use of cephalic vein 47 |
Pericardial effusion | 1.5% | Use of soft-tip guides and access tools |
Hematoma | 3%-6% | Avoid low molecular weight heparin periprocedurally 33 |
Phrenic nerve stimulation | Up to 13% | Conscious sedation; no paralytic agents; identify all available coronary vein branches; use of multipolar leads (additional electrodes) |
Lead-related complications | 3.5%-18.7% 29 | Appropriate training and adequate procedural volumes |
Device infection | 1.3%-2.6% | Appropriate antibiotic prophylaxis before skin incision 48 ; chlorhexidine skin preparation49 ; limited shaving |
In-hospital mortality | 0.3% | Careful preoperative assessment; intraoperative monitoring; appropriate postoperative care |
Operative considerations related to CRT upgrade
Lead placement to optimize response
Practical tip
Tool | Measurement |
---|---|
Imaging | Echocardiography, nuclear, CMR |
Anatomic position | LV lead to latest activation site determined using imaging |
Greatest distance between LV and RV lead | |
Timing | Greatest delay from onset of QRS to local LV electrogram |
Contractility | Acute increase in dP/dtmax or pulse pressure (systolic minus diastolic blood pressure) |
Endocardial pacing
Device Follow-up
Factors to consider in CRT follow-up

Optimization of medications
Definition of response
Study | Definition of CRT response | Follow-up (months) | Predictors of CRT response |
---|---|---|---|
Lecoq et al. 68 | Alive, no HF readmission, > 1 NYHA class improvement (or > 10% increase in peak VO2 and 6MW) | 6 | QRS shortening during CRT |
Achilli et al. 69 | Improved clinical composite score and LVEF increase ≥ 5% | 6 | Smaller LVESD, longer interventricular mechanical delay |
MIRACLE/ MIRACLE ICD 6 , 7 | Alive and > 1 NYHA class improvement | 1, 3, and 6 | None |
Yeim et al. 70 | > 1 NYHA class improvement and no HF admission | 6 | Nonischemic etiology, wider baseline QRS width, QRS shortening during CRT |
Mollema et al. 71 | ≥ 1 NYHA class improvement or 10% decrease in LVESV | 6 | None |
PROSPECT 72 | Improved clinical composite score and LVESV decrease ≥ 15% | 6 | None |
Buck et al. 73 | LVESV decrease > 10% | 6 | Interlead distance > 127 mm, septal-lateral delay > 60 ms, nonischemic etiology, LV end-diastolic diameter < 67 mm, use of ACE inhibitor, absence of tricuspid regurgitation |
Rickard et al. 74 | LVESV decrease ≥ 10% | > 2 | Wider QRS |
MADIT-CRT 75 | % decrease in LVEDV and response score | 12 | Female, nonischemic etiology, LBBB, QRS > 150 ms, previous HF hospitalization, LVEDV > 125 mL/m2, left atrial volume < 40 mL/m2 |
PROSPECT-ECG 57 , 76 | Improved clinical composite score, LVESV decrease ≥ 15% | 6 | LBBB morphology, LV paced QRS width and QRS shortening |
Practical tip
Evaluation of response during follow-up and approach to CRT nonresponse
- Rao R.K.
- Kumar U.N.
- Schafer J.
- Viloria E.
- De L.D.
- Foster E.
- Abraham W.T.
- Gras D.
- Yu C.M.
- Guzzo L.
- Gupta M.S.
- Ellenbogen K.A.
- Gold M.R.
- Meyer T.E.
- et al.
Super-response to CRT
- Hsu J.C.
- Solomon S.D.
- Bourgoun M.
- et al.
Optimal timing for assessment of response
- 8.We recommend that alterations in clinical parameters after vs before CRT be assessed within 6 to 12 months after CRT implantation to guide ongoing HF management (Strong Recommendation, Low-Quality Evidence).
Study | Comparison | Results |
---|---|---|
RHYTHM II 83 | Echo-optimized VV timing vs nominal VV settings | No difference in QOL, NYHA or 6MW |
DECREASE-HF 85
Reduced ventricular volumes and improved systolic function with cardiac resynchronization therapy: a randomized trial comparing simultaneous biventricular pacing, sequential biventricular pacing, and left ventricular pacing. Circulation. 2007; 115: 2136-2144 | Simultaneous VV pacing vs EGM optimized VV timing | No difference in LV volumes or EF |
FREEDOM 86
Rationale and design of a randomized clinical trial to assess the safety and efficacy of frequent optimization of cardiac resynchronization therapy: the Frequent Optimization Study Using the QuickOpt Method (FREEDOM) trial. Am Heart J. 2010; 159: 944-948 | Clinically optimized AV and VV timing vs serial EGM optimized AV and VV timing | No difference in clinical outcomes or functional measures |
CLEAR 84 | Echo optimized AV and VV timing vs automatic adjustment of AV delays via contractility sensor | Improved clinical response with the contractility sensor |
SMART AV 87
Primary results from the SmartDelay determined AV optimization: a comparison to other AV delay methods used in cardiac resynchronization therapy (SMART-AV) trial: a randomized trial comparing empirical, echocardiography-guided, and algorithmic atrioventricular delay programming in cardiac resynchronization therapy. Circulation. 2010; 122: 2660-2668 | Echo optimized AV and VV timing vs EGM optimized AV and VV timing vs fixed AV (120 ms) and VV (0 ms) | No difference in LV volumes, EF, or functional measures |
Remote monitoring
Practical tip
Referral for cardiac transplantation and mechanical circulatory support
Assessment of a patient at the time of pulse generator change

Device and lead advisories
Deactivation of ICD therapy
Health Economics and Accessibility of CRT
Regional issues
Wait times
Cost/benefit
- Linde C.
- Mealing S.
- Hawkins N.
- Eaton J.
- Brown B.
- Daubert J.C.
Summary and Future Directions
Acknowledgements
Supplementary Material
- Supplementary Material
References
- GRADE: an emerging consensus on rating quality of evidence and strength of recommendations.BMJ. 2008; 336: 924-926
- HFSA 2010 Comprehensive Heart Failure Practice Guideline.J Card Fail. 2010; 16: e1-194
- Assessment of functional capacity in clinical and research settings: a scientific statement from the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing.Circulation. 2007; 116: 329-343
- Echocardiographic modeling of cardiac dyssynchrony before and during multisite stimulation: a prospective study.Pacing Clin Electrophysiol. 2003; 26: 137-143
- Impact of biventricular pacing on mortality in a randomized crossover study of patients with heart failure and ventricular arrhythmias.Pacing Clin Electrophysiol. 2000; 23: 1711-1712
- Cardiac resynchronization in chronic heart failure.N Engl J Med. 2002; 346: 1845-1853
- Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial.JAMA. 2003; 289: 2685-2694
- Randomised, placebo-controlled trial of carvedilol in patients with congestive heart failure due to ischaemic heart disease. Australia/New Zealand Heart Failure Research Collaborative Group.Lancet. 1997; 349: 375-380
- Six minute corridor walk test as an outcome measure for the assessment of treatment in randomized, blinded intervention trials of chronic heart failure: a systematic review.Eur Heart J. 2005; 26: 778-793
- How many patients with heart failure are eligible for cardiac resynchronization? Insights from two prospective cohorts.Eur Heart J. 2006; 27: 323-329
- Canadian Cardiovascular Society guidelines on the use of cardiac resynchronization therapy: evidence and patient selection.Can J Cardiol. 2013; 29: 182-195
- Cardiac resynchronization therapy: a meta-analysis of randomized controlled trials.CMAJ. 2011; 183: 421-429
- Efficacy of cardiac resynchronization therapy in very old patients: the Insync/Insync ICD Italian Registry.Europace. 2007; 9: 732-738
- Renal insufficiency and heart failure: prognostic and therapeutic implications from a prospective cohort study.Circulation. 2004; 109: 1004-1009
- Device therapy in heart failure patients with chronic kidney disease.J Am Coll Cardiol. 2011; 58: 889-896
- Response to cardiac resynchronization therapy in patients with heart failure and renal insufficiency.Pacing Clin Electrophysiol. 2010; 33: 850-859
- Cardiac resynchronization therapy improves renal function in human heart failure with reduced glomerular filtration rate.J Card Fail. 2008; 14: 539-546
- Clinical characteristics and in-hospital outcome of patients with end-stage renal disease on dialysis referred for implantable cardioverter-defibrillator implantation.Heart Rhythm. 2009; 6: 1565-1571
- Cardiac-resynchronization therapy for the prevention of heart-failure events.N Engl J Med. 2009; 361: 1329-1338
- Cardiac-resynchronization therapy for mild-to-moderate heart failure.N Engl J Med. 2010; 363: 2385-2395
- Long-term left ventricular reverse remodelling with cardiac resynchronization therapy: results from the CARE-HF trial.Eur J Heart Fail. 2009; 11: 480-488
- A risk score predicting non sudden cardiac death in congestive heart failure.Can J Cardiol. 2006; 22: 185D
- Frailty in elderly people: an evolving concept.CMAJ. 1994; 150: 489-495
- A global clinical measure of fitness and frailty in elderly people.CMAJ. 2005; 173: 489-495
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- Biventricular pacing for atrioventricular block and systolic dysfunction.N Engl J Med. 2013; 368: 1585-1593
- Impact of upgrade to cardiac resynchronization therapy on ventricular arrhythmia frequency in patients with implantable cardioverter-defibrillators.J Am Coll Cardiol. 2005; 46: 2258-2263
- The benefit of upgrading chronically right ventricle-paced heart failure patients to resynchronization therapy demonstrated by strain rate imaging.Heart Rhythm. 2006; 3: 435-442
- Complication rates associated with pacemaker or implantable cardioverter-defibrillator generator replacements and upgrade procedures: results from the REPLACE registry.Circulation. 2010; 122: 1553-1561
- Surgical epicardial left ventricular lead versus coronary sinus lead placement in biventricular pacing.Eur J Cardiothorac Surg. 2005; 27: 235-242
- Implantation of left ventricular epicardial leads in cardiosurgical patients with impaired cardiac function–a worthwhile procedure in concomitant surgical interventions?.Thorac Cardiovasc Surg. 2012; 60: 64-69
- Ventricular epicardial lead placement for resynchronization by determination of paced depolarization intervals: technique and rationale.Ann Thorac Surg. 2007; 83: 89-92
- Pacemaker or defibrillator surgery without interruption of anticoagulation.N Engl J Med. 2013; 368: 2084-2093
- Meta-analysis of safety and efficacy of uninterrupted warfarin compared to heparin-based bridging therapy during implantation of cardiac rhythm devices.Am J Cardiol. 2012; 110: 1482-1488
- Perioperative management of antithrombotic therapy: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.Chest. 2012; 141: e326S-e350S
- Multifactorial index of cardiac risk in noncardiac surgical procedures.N Engl J Med. 1977; 297: 845-850
- Infection control and prevention in perioperative practice.J Perioper Pract. 2008; 18: 274-278
- Risk to patients from radiation associated with radiofrequency ablation for supraventricular tachycardia.Circulation. 1998; 98: 1534-1540
- HRS/EHRA/ECAS expert Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation.Heart Rhythm. 2007; 4: 816-861
- X-ray exposure hazards for physicians performing ablation procedures and device implantation: results of the European Heart Rhythm Association survey.Europace. 2013; 15: 444-446
- Evaluation of a radiation protection cabin for invasive electrophysiological procedures.Eur Heart J. 2007; 28: 183-189
- Reducing operator radiation exposure during cardiac resynchronization therapy.Europace. 2010; 12: 1769-1773
- Improving safety in the electrophysiology laboratory using a simple radiation dose reduction strategy: a study of 1007 radiofrequency ablation procedures.Heart. 2011; 97: 366-370
- Canadian Cardiovascular Society Position Statement on radiation exposure from cardiac imaging and interventional procedures.Can J Cardiol. 2013; 29: 1361-1368
- Physician procedure volume and complications of cardioverter-defibrillator implantation.Circulation. 2012; 125: 57-64
- Contrast nephropathy post cardiac resynchronization therapy: an under-recognized complication with important morbidity.Eur J Heart Fail. 2005; 7: 899-903
- A comparison of lead placement through the subclavian vein technique with fluoroscopy-guided axillary vein technique for permanent pacemaker insertion.Can J Cardiol. 2012; 28: 542-546
- Lead-associated endocarditis: the important role of methicillin-resistant Staphylococcus aureus.Pacing Clin Electrophysiol. 2008; 31: 548-553
- Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis.N Engl J Med. 2010; 362: 18-26
- Implant venoplasty: dilation of subclavian and coronary veins to facilitate device implantation: indications, frequency, methods, and complications.J Cardiovasc Electrophysiol. 2008; 19: 1004-1007
- Lead extraction is preferred for lead revisions and system upgrades: when less is more.Circ Arrhythm Electrophysiol. 2010; 3: 413-424
- Lead extraction in the contemporary setting: the LExICon study: an observational retrospective study of consecutive laser lead extractions.J Am Coll Cardiol. 2010; 55: 579-586
- Left ventricular lead position and clinical outcome in the multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy (MADIT-CRT) trial.Circulation. 2011; 123: 1159-1166
- Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy.Circulation. 2006; 113: 969-976
- Impact of viability and scar tissue on response to cardiac resynchronization therapy in ischaemic heart failure patients.Eur Heart J. 2007; 28: 33-41
- Delayed enhancement magnetic resonance imaging predicts response to cardiac resynchronization therapy in patients with intraventricular dyssynchrony.J Am Coll Cardiol. 2006; 48: 1953-1960
- Contemporary and future trends in cardiac resynchronization therapy to enhance response.Heart Rhythm. 2012; 9: S27-S35
- Targeted left ventricular lead placement to guide cardiac resynchronization therapy: the TARGET study: a randomized, controlled trial.J Am Coll Cardiol. 2012; 59: 1509-1518
- Echocardiography-guided left ventricular lead placement for cardiac resynchronization therapy: results of the speckle tracking assisted resynchronization therapy for electrode region trial.Circ Heart Fail. 2013; 6: 427-434
- Coronary magnetic resonance vein imaging: imaging contrast, sequence, and timing.Magn Reson Med. 2007; 58: 1196-1206
- Cardiac magnetic resonance assessment of dyssynchrony and myocardial scar predicts function class improvement following cardiac resynchronization therapy.JACC Cardiovasc Imaging. 2008; 1: 561-568
- Late gadolinium enhancement-cardiovascular magnetic resonance as a predictor of response to cardiac resynchronization therapy in patients with ischaemic cardiomyopathy.Europace. 2007; 9: 1031-1037
- Integrating functional and anatomical information to guide cardiac resynchronization therapy.Eur J Heart Fail. 2010; 12: 52-57
- The relationship between ventricular electrical delay and left ventricular remodelling with cardiac resynchronization therapy.Eur Heart J. 2011; 32: 2516-2524
- Optimal left ventricular endocardial pacing sites for cardiac resynchronization therapy in patients with ischemic cardiomyopathy.J Am Coll Cardiol. 2010; 56: 774-781
- Guidelines for implantable cardioverter defibrillator follow-up in Canada: a consensus statement of the Canadian Working Group on Cardiac Pacing.Can J Cardiol. 2003; 19: 21-37
- Foreseeing super-response to cardiac resynchronization therapy: a perspective for clinicians.J Am Coll Cardiol. 2012; 59: 2374-2377
- Clinical and electrocardiographic predictors of a positive response to cardiac resynchronization therapy in advanced heart failure.Eur Heart J. 2005; 26: 1094-1100
- Prediction of response to cardiac resynchronization therapy: the selection of candidates for CRT (SCART) study.Pacing Clin Electrophysiol. 2006; 29: S11-S19
- Predictors of a positive response to biventricular pacing in patients with severe heart failure and ventricular conduction delay.Pacing Clin Electrophysiol. 2007; 30: 970-975
- Usefulness of QRS duration to predict response to cardiac resynchronization therapy in patients with end-stage heart failure.Am J Cardiol. 2007; 100: 1665-1670
- Results of the Predictors of Response to CRT (PROSPECT) trial.Circulation. 2008; 117: 2608-2616
- Impact of interventricular lead distance and the decrease in septal-to-lateral delay on response to cardiac resynchronization therapy.Europace. 2008; 10: 1313-1319
- Predictors of response to cardiac resynchronization therapy in patients with a non-left bundle branch block morphology.Am J Cardiol. 2011; 108: 1576-1580
- Predictors of response to cardiac resynchronization therapy in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT).Circulation. 2011; 124: 1527-1536
- Paced left ventricular QRS width and ECG parameters predict outcomes after cardiac resynchronization therapy: PROSPECT-ECG substudy.Circ Arrhythm Electrophysiol. 2011; 4: 851-857
- Agreement is poor among current criteria used to define response to cardiac resynchronization therapy.Circulation. 2010; 121: 1985-1991
- Long-term prognosis after cardiac resynchronization therapy is related to the extent of left ventricular reverse remodeling at midterm follow-up.J Am Coll Cardiol. 2009; 53: 483-490
- Early and sustained effects of cardiac resynchronization therapy on N-terminal pro-B-type natriuretic peptide in patients with moderate to severe heart failure and cardiac dyssynchrony.Eur Heart J. 2007; 28: 1592-1597
- Long-term outcome after ICD and CRT implantation and influence of remote device follow-up: The ALTITUDE Survival Study.Circulation. 2010; 122: 2359-2367
- Outcomes of cardiac resynchronization therapy in patients with versus those without atrial fibrillation: a systematic review and meta-analysis.Heart Rhythm. 2011; 8: 1088-1094
- Radiofrequency ablation of premature ventricular ectopy improves the efficacy of cardiac resynchronization therapy in nonresponders.J Am Coll Cardiol. 2012; 60: 1531-1539
- A prospective randomized evaluation of VV delay optimization in CRT-D recipients: echocardiographic observations from the RHYTHM II ICD study.Pacing Clin Electrophysiol. 2009; 32: S120-S125
- A randomized pilot study of optimization of cardiac resynchronization therapy in sinus rhythm patients using a peak endocardial acceleration sensor vs. standard methods.Europace. 2012; 14: 1324-1333
- Reduced ventricular volumes and improved systolic function with cardiac resynchronization therapy: a randomized trial comparing simultaneous biventricular pacing, sequential biventricular pacing, and left ventricular pacing.Circulation. 2007; 115: 2136-2144
- Rationale and design of a randomized clinical trial to assess the safety and efficacy of frequent optimization of cardiac resynchronization therapy: the Frequent Optimization Study Using the QuickOpt Method (FREEDOM) trial.Am Heart J. 2010; 159: 944-948
- Primary results from the SmartDelay determined AV optimization: a comparison to other AV delay methods used in cardiac resynchronization therapy (SMART-AV) trial: a randomized trial comparing empirical, echocardiography-guided, and algorithmic atrioventricular delay programming in cardiac resynchronization therapy.Circulation. 2010; 122: 2660-2668
- Predictors of super-response to cardiac resynchronization therapy and associated improvement in clinical outcome: the MADIT-CRT (multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy) study.J Am Coll Cardiol. 2012; 59: 2366-2373
- Identification of ‘super-responders' to cardiac resynchronization therapy: the importance of symptom duration and left ventricular geometry.Europace. 2009; 11: 343-349
- Predicting the long-term effects of cardiac resynchronization therapy on mortality from baseline variables and the early response a report from the CARE-HF (Cardiac Resynchronization in Heart Failure) Trial.J Am Coll Cardiol. 2008; 52: 438-445
- The effect of cardiac resynchronization on morbidity and mortality in heart failure.N Engl J Med. 2005; 352: 1539-1549
- Cardiac resynchronization therapy in mild heart failure.Europace. 2009; 11: v72-v76
- Canadian Cardiovascular Society/Canadian Heart Rhythm Society Joint Position Statement on the Use of Remote Monitoring for Cardiovascular Implantable Electronic Device Follow-up.Can J Cardiol. 2013; 29: 644-651
- The 2011 Canadian Cardiovascular Society heart failure management guidelines update: focus on sleep apnea, renal dysfunction, mechanical circulatory support, and palliative care.Can J Cardiol. 2011; 27: 319-338
- Recalls and safety alerts involving pacemakers and implantable cardioverter-defibrillator generators.JAMA. 2001; 286: 793-799
- Complications associated with revision of Sprint Fidelis leads: report from the Canadian Heart Rhythm Society Device Advisory Committee.Circulation. 2010; 121: 2384-2387
- Sprint Fidelis lead fractures in patients with cardiac resynchronization therapy devices: insight from the Resynchronization/Defibrillation for Ambulatory Heart Failure (RAFT) study.Circulation. 2012; 126: 2928-2934
- Prevalence and predictors of off-label use of cardiac resynchronization therapy in patients enrolled in the National Cardiovascular Data Registry Implantable Cardiac-Defibrillator Registry.J Am Coll Cardiol. 2010; 56: 766-773
- Canadian Cardiovascular Society Access to Care Workshop proceedings and next steps.Can J Cardiol. 2010; 26: 69-71
- Universal access–but when? Treating the right patient at the right time: access to electrophysiology services in Canada.Can J Cardiol. 2006; 22: 741-746
- Economic analysis of a randomized trial of biventricular pacing in Canada.Pacing Clin Electrophysiol. 2007; 30: 38-43
- Cost-effectiveness of cardiac resynchronization therapy in patients with symptomatic heart failure.Ann Intern Med. 2004; 141: 343-351
- Cost-effectiveness of cardiac resynchronization therapy: results from the CARE-HF trial.Eur Heart J. 2005; 26: 2681-2688
- Cost effectiveness of cardiac resynchronization therapy in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) trial.J Am Coll Cardiol. 2005; 46: 2311-2321
- Cost-effectiveness of cardiac resynchronization therapy in patients with asymptomatic to mild heart failure: insights from the European cohort of the REVERSE (Resynchronization Reverses remodeling in Systolic Left Ventricular Dysfunction).Eur Heart J. 2011; 32: 1631-1639
- Cost-effectiveness of cardiac resynchronization therapy in the MADIT-CRT trial.J Cardiovasc Electrophysiol. 2013; 24: 66-74
- Is cardiac resynchronization therapy cost-effective?.Europace. 2009; 11: v93-v97
Article Info
Publication History
Footnotes
The disclosure information of the authors and reviewers is available from the CCS on the following websites: www.ccs.ca and/or www.ccsguidelineprograms.ca.
This statement was developed following a thorough consideration of medical literature and the best available evidence and clinical experience. It represents the consensus of a Canadian panel comprised of multidisciplinary experts on this topic with a mandate to formulate disease-specific recommendations. These recommendations are aimed to provide a reasonable and practical approach to care for specialists and allied health professionals obliged with the duty of bestowing optimal care to patients and families, and can be subject to change as scientific knowledge and technology advance and as practice patterns evolve. The statement is not intended to be a substitute for physicians using their individual judgement in managing clinical care in consultation with the patient, with appropriate regard to all the individual circumstances of the patient, diagnostic and treatment options available and available resources. Adherence to these recommendations will not necessarily produce successful outcomes in every case.