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VIEWPOINT AND COMMENTARY

There Is Plenty of Room for Cardiac Resynchronization Therapy Devices Without Back-Up Defibrillators in the Electrical Treatment of Heart Failure

Department of Cardiology, Centre Hospitalier Universitaire, Rennes, France

Manuscript received August 4, 2005; accepted August 9, 2005.

^_* Reprint requests and correspondence: Dr. Jean-Claude Daubert, Centre Hospitalier Universitaire, Department of Cardiology, F-35000 Rennes, France. (Email: jean-claude.daubert{at}chu-rennes.fr).

Patients with chronic heart failure might benefit from electrical therapy with a view to resynchronize the heart and improve its mechanical performance by cardiac resynchronization therapy (CRT) or to prevent the risk of sudden death by automatic defibrillation. These two therapies can be applied separately or with a combined device, the biventricular implantable cardioverter-defibrillator (CRT-D). There is currently no strong scientific evidence indicating that a CRT-D must be offered to all candidates for CRT. Plain common sense should limit the prescription of these costly devices for patients in need of secondary prevention or for younger patients without major comorbidities. The preferential choice of CRT pacemakers in the remainder of patients is currently a logical one.

Abbreviations and Acronyms   ARR = absolute risk reduction   CHF = chronic heart failure   CRT-D = cardiac resynchronization therapy by biventricular defibrillation   CRT-P = pacemaker for cardiac resynchronization therapy   EF = ejection fraction   ICD = implantable cardioverter-defibrillator   LV = left ventricular   NYHA = New York Heart Association   RRR = relative reduction in the risk of overall mortality

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