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Debate - Part 2

CRT-D Should be the Device of Choice in Patients Undergoing Resynchronization Therapy

Volume 2, Jan 2013

Ajit Thachil MD, DM Kochi, India

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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