Abstract

Recent studies have provided the impetus to update the recommendations for cardiac resynchronization therapy (CRT). This article provides guidance on the implementation of CRT and is intended to serve as a framework for the implementation of CRT within the Canadian health care system and beyond. These guidelines were developed through a critical evaluation of the existing literature, and expert consensus. The panel unanimously adopted each recommendation. The 9 recommendations relate to patient selection in the presence of comorbidities, delivery and optimization of CRT, and resources required to deliver this therapy. The strength of evidence was weighed, taking full consideration of any risk of bias, and any imprecision, inconsistency, and indirectness of the available data. The strength of each recommendation and the quality of evidence were adjudicated. Trade-offs between desirable and undesirable consequences of alternative management strategies were considered, as were values, preferences, and resource availability. These guidelines were externally reviewed by experts, modified based on those reviews, and will be updated as new knowledge is acquired.

Introduction

The 9 recommendations in this document are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessment method and expert consensus. This document was developed to directly address the practical use of cardiac resynchronization therapy (CRT), beyond clinical trial inclusion/exclusion criteria, in a realworld population. The consensus panel consisted of experts in cardiac electrophysiology, heart failure (HF), cardiac surgery, cardiac imaging, general cardiology, internal medicine, knowledge translation, and health services. Competing interests of panel members are provided on the Canadian Cardiovascular Society (CCS) Web site (www.ccs.ca). These guidelines are intended for internists, nurse clinicians in heart function and device clinics, general cardiologists, HF experts, cardiac electrophysiologists, policy makers, and trainees. This document is meant to provide guidance for patient selection, platform selection, and appropriate preoperative, operative, and postoperative patient management to reduce risk, and optimize CRT delivery. The economics and accessibility of CRT are also addressed, including the timely application of this therapy.