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Management of Heart Failure After Cardiac Resynchronization Therapy

Integrating Advanced Heart Failure Treatment With Optimal Device Function

Juan M. Aranda, Jr, MD, FACC^_*,_*, Gregory W. Woo, MD^_*, Richard S. Schofield, MD, FACC^_*, Eileen M. Handberg, ARNP, PhD^_*, James A. Hill, MD, FACC^_*, Anne B. Curtis, MD, FACC^_*, Samuel F. Sears, PhD, J. Sean Goff, ARNP^_*, Daniel F. Pauly, MD, FACC^_* and Jamie B. Conti, MD, FACC^_*

^_* Division of Cardiovascular Medicine, College of Medicine, University of Florida Health Science Center, Gainesville, Florida
Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida Health Science Center, Gainesville, Florida.

View larger version (36K): [in a new window]   Figure 1 Troubleshooting algorithm for heart failure patients with worsening symptoms, progressive ventricular remodeling, or no improvement in New York Heart Association functional class despite one to six months of cardiac resynchronization therapy (CRT). AV = atrioventricular; CXR = chest X-ray; EKG = electrocardiogram; Htx = heart transplant; LV = left ventricular; LVAD = left ventricular assist device; MR = mitral regurgitation; RV = right ventricular; VV = interventricular. *Cardiac ischemia is evaluated in patients with ischemic cardiomyopathy. **Evidence of dyssynchrony includes septal to posterior wall motion delay 130 ms, intraventricular mechanical delay 40 ms, and tissue Doppler imaging 65 ms.