Should all patients with heart failure and left ventricular dysfunction receive combined CRT–ICD therapy?

Rainer Gradaus and Günter Breithardt*

This article has no abstract so we have provided the first paragraph of the full text.

Electrical device therapy has gained increasing importance for the management of LV dysfunction and HF. The MADIT II¹ and SCD-HeFT² trials showed that, in the absence of a prior arrhythmic event (primary prevention), ICDs reduced all-cause mortality in advanced LV dysfunction after myocardial infarction and in moderate to severe congestive HF, respectively. Furthermore, in the CARE-HF trial,³ restoration of LV synchrony by CRT led to an improvement in symptoms, exercise capacity, and reduced the need for hospitalization. Moreover, the CARE-HF trial not only demonstrated a reduction in all-cause mortality, but also reported a significant reduction in arrhythmic deaths during the extension phase of the trial.³ By contrast, in the COMPANION study,⁴ improvement in patient survival with CRT alone approached, but did not reach, statistical significance, but combined CRT–ICD did significantly improve survival. The lack of significance for CRT alone might have been because the COMPANION trial was terminated when the primary endpoint was reached for the CRT–ICD arm.

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