Combination of Cardiac Resynchronization Therapy (CRT) and Implanted Cardioverter-Defibrillator (ICD) May Reduce Death and Hospitalization for Heart Failure
DynaMed Weekly Update - Volume 5, Issue 51
Previous trials investigating CRT (biventricular pacing) combined with an ICD in patients with heart failure have shown non-significant improvements in mortality compared to ICD monotherapy. A new trial compared the combination of CRT plus ICD vs. ICD alone in 1,798 patients with mild to moderate heart failure (NYHA class II or III) and wide QRS complex (? 120 milliseconds) despite optimal medical therapy. At mean follow-up of 40 months, combination therapy was associated with reduced risk of all-cause mortality (20.8% vs. 26.1%, p = 0.003, NNT 19) and cardiovascular mortality (14.5% vs. 17.9%, p = 0.02, NNT 30) (level 2 [mid-level] evidence). Rates of hospitalization for heart failure were also lower for the combination group (19.5% vs. 26.1%, p < 0.001, NNT 15). Combination therapy was associated with a higher rate of implantation-related complications (p < 0.001), most commonly lead displacement requiring intervention. There were no significant differences in a subgroup analysis of 360 patients with NYHA class III heart failure. This trial was funded in part by Medtronic of Canada, manufacturer of both devices (N Engl J Med 2010 Dec 16;363(25):2385).
For more information, see the Implanted cardiac devices for heart failure topic in DynaMed.