Dyssynchronous ventricular contraction in selected heart failure patients can worsen symptoms, reduce ejection fraction, and increase hospitalization risk, making Cardiac Resynchronization Therapy (CRT) a transformative treatment option. This session explores how CRT—using biventricular or conduction system pacing—improves mechanical coordination, reverses remodeling, and enhances quality of life. Participants will review guideline-based indications, including QRS duration and morphology, ejection fraction thresholds, and symptom status, along with nuances in ischemic versus non-ischemic cardiomyopathy.

Given the complexity of patient selection and device management, many clinicians attend a cardiology conference to refine their decision-making. This session walks through pre-implant evaluation, including echocardiography, ECG analysis, and assessment of comorbidities such as atrial fibrillation or significant valvular disease. Attendees will learn about coronary sinus anatomy, LV lead placement strategies, and alternatives when coronary sinus access is challenging. Real-world cases highlight common dilemmas: borderline QRS duration, frequent PVCs, right ventricular pacing–induced cardiomyopathy, and coexisting indications for ICD therapy.

A major focus is optimizing cardiac resynchronization therapy outcomes after implantation. Participants will explore device programming strategies—AV and VV delay optimization, rate response, and management of arrhythmia detection—and how to recognize and address CRT nonresponse. The session discusses the role of advanced imaging and electroanatomic mapping in refining lead position, as well as options for upgrades from conventional pacing to CRT or conduction system pacing. Coordination with heart failure teams is emphasized to ensure parallel optimization of pharmacologic therapy and comorbidity management.

The session concludes with future directions, including multipoint pacing, physiologic CRT via His-bundle or left bundle pacing, and integration with remote monitoring and AI-based response prediction. By the end, attendees will have a comprehensive framework for selecting appropriate CRT candidates, performing or supporting implants, and running long-term follow-up programs that maximize patient benefit.