Abstract
Cardiac resynchronization therapy (CRT) improves symptoms and prolongs life in selected patients with heart failure and systolic dysfunction. Newer studies suggest important benefits in earlier stages of heart failure, which may stave off future development of severe symptoms and may even improve cardiomyopathy primarily. CRT can be offered with and without defibrillator therapy, which may extend its potential to prolong life at the cost of increased complications. However, no formal guidelines exist regarding the content of informed consent for CRT. Considerations regarding quality of life, length of life and personal autonomy may influence device selection, and clinical uncertainty regarding the likelihood of individual response to therapy adds further challenges to decision-making. As indications for implantation expand, these features of CRT should be explicitly included in the informed consent process to help physicians and patients make individualized choices and guide them through complex decisions.