The addition of cardiac resynchronization to medical therapy alleviates heart failure, and improves mortality in certain patient subsets. Whether a combination device that is additionally capable of cardioversion-defibrillation would further improve outcomes has not been systematically studied in most patient subgroups. The proven benefit of implantable cardioverter defibrillators in milder forms of heart failure should make a combined device the therapy of choice in NYHA Class I and II heart failure. Sufficient data exist to show that a combined device is more beneficial than a resynchronization-only device in NYHA III heart failure. The device of choice should be individualized in NYHA IV heart failure; among these patients, it may be easier to implant a combined device and turn off tachyarrhythmia therapies if and when not desired, than to have a resynchronization-only device. Cost considerations should be individualized as far as possible while choosing these devices.
 

Key Words: Resynchronization, CRT, CRTD, heart failure

Volume 2, Number 1, Pages: 32-36

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