Problem Heart failure (NYHA I-II; EF < 30%; QRS > 130ms)
Format Double-blinded multi-center RCT
Treatment ICD-CRT
Control ICD only
Population 1820 patients
Inclusion criteria Patients of either sex who were at least 21 years of age could participate in the study if they had ischemic cardiomyopathy (NYHA class I or II) or nonischemic cardiomyopathy (NYHA class II only), sinus rhythm, an ejection fraction of 30% or less, and prolonged intraventricular conduction with a QRS duration of 130 msec or more. All eligible subjects met the guideline indication for ICD therapy.
Exclusion criteria Patients were excluded from enrollment for a variety of reasons, including an existing indication for CRT; having an implanted pacemaker, ICD, or resynchronization device; NYHA class III or IV symptoms, previous coronary-artery bypass grafting, percutaneous coronary intervention, or an enzyme-positive myocardial infarction within 3 months before enrollment; atrial fibrillation within 1 month before enrollment;
Follow-up Median 2.4 years
Primary endpoint Death from any cause or a nonfatal heart-failure event (whichever came first)
Secondary endpoint(s) -
Details 1820 patients with
-ischaemic or non-ischaemic cardiomyopathy
-ejection fraction of <30%
-QRS duration of >130 msec
-New York Heart Association class I or II
Brief summary: CRT (added to ICD) reduced CCF exasc in well low EF patients
PAPER: Cardiac-resynchronization therapy for the prevention of heart-failure events.
Date 1 Oct 2009
Journal N Engl J Med. 2009 Oct 1;361(14):1329-38. Epub 2009 Sep 1.
Information ICD-CRT (vs. ICD alone):
-41% (significant) reduction in heart-failure exascerbations (ARR 8.9%)
--Similar benefits for ischaemic & non-ischaemic cardiomyopathy
-Significant reduction in LV volume & EF improvement
-Similar risks of death (3%/yr)
-Greatest benefit when QRS > 150ms