Biventricular resynchronisation is accepted as an effective alternative treatment for patients with refractory dilated cardiomyopathy. Based on the presence of ventricular asynchrony, the objective of this technique is to restore homogenous contraction of the myocardial walls. The electrocardiographic criteria for selecting patients only generates a response rate in the order of 70%. Echocardiography has been suggested as another tool for evaluating asynchrony, but there is much confusion in the application of the different criteria. Here we propose an approach based on an understanding of the complexity of myocardial contraction in order to integrate the different echocardiographic parameters in a logical overall evaluation of asynchrony.

However, the role of echography does not end with pre-implantation evaluation alone. The follow up of resynchronised patients can effectively benefit from all the opportunities of functional, morphological and hemodynamic investigation, that ultrasound provides. From confirmation of the efficacy of resynchronisation to optimising the pacemaker, the applications of echographic investigation in this field are widespread.