Cadiac resynchrnonisation (CRT) therapy , is the most famed as well as ridiculed treatment modality for refractory failure . It is facing a real tough time for survival now .(At least in class 4 CHF.)
Confident and authentic data are emerging now , that CRT should not be used in advanced heart failure .(This is in total contrast with the original concept , when CRT was introduced nearly a decade ago ! more of class 3 and 4 were enrolled ) . Bad outcomes are expected in advanced CHF. This is something similar to whipping the tired horse concept which found inotropes to increase the mortality in severe heart failure .
The article in the current issue of circulation shows no mercy to CRT in advanced CHF
http://circ.ahajournals.org/cgi/content/abstract/CIRCULATIONAHA.110.956011v1
So what is the answer to the ailing CRT industry ?
Go and catch class 1 and class 2 CHF population* .You will get plenty , of course it got ratified by MADIT -CRT trial .
* It is attractively called prevention of cardiac failure
Dr.S.Venkatesan MD 
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