Skip to main content
SpringerLink
Log in

A plea for the wider use of CRT-P in candidates for cardiac resynchronisation therapy

  • Published:
Heart Failure Reviews Aims and scope Submit manuscript

Abstract

Spectacular developments have taken place, in the last 10 years, in the device-based management of heart failure (HF). Patients presenting with chronic HF may benefit from a device implanted with a view to: (1) resynchronise the pump function of a discoordinated failing heart or (2) prevent sudden arrhythmic death by automatic cardioversion or defibrillation. This “point-of-view” article reviews the large amount of information gathered in the past 10 years on the use of cardiac resynchronisation therapy (CRT), with or without cardioverter defibrillator (ICD), and puts in perspective the advisability of using one, the other or both treatments in distinct patient subsets. There is currently no strong scientific evidence supporting the systematic implantation of CRT-ICD (CRT-D) instead of CRT pacemakers (CRT-P). Plain common sense should limit the prescription of these costly and complicated devices to patients in need of secondary prevention of ventricular arrhythmias or, for primary prevention, in younger patients without major concomitant illnesses. The preferential choice of CRT-P for the remainder of ambulatory patients in New York Heart Association (NYHA) functional class III or IV is currently acceptable. Because of insufficient data regarding the performance of CRT-P in patients presenting in NYHA functional class I or II, CRT-D is currently the device of choice for this sub-population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Uretsky BF, Sheahan RG (1997) Primary prevention of sudden cardiac death in heart failure: will the solution be shocking? J Am Coll Cardiol 30:1589–1597

    Article  PubMed  CAS  Google Scholar 

  2. MERIT-HF Study Group (1999) Effect of metoprolol CR/XL in chronic heart failure: metoprolol CR/XL, randomised intervention trial in congestive heart failure (MERIT-HF). Lancet 353:2001–2007

    Article  Google Scholar 

  3. Bardy GH, Lee KL, Mark DB et al (2005) Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 352:225–237

    Article  PubMed  CAS  Google Scholar 

  4. Task Force for Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of European Society of Cardiology, Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the task force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 29:2388–2442

    Article  PubMed  CAS  Google Scholar 

  5. Jessup M, Abraham WT, Casey DE et al (2009) 2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119:1977–2016

    Article  PubMed  Google Scholar 

  6. Cazeau S, Leclercq C, Lavergne T et al (2001) Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 344:873–880

    Article  PubMed  CAS  Google Scholar 

  7. Abraham WT, Fisher WG, Smith AL, MIRACLE Study Group. Multicenter InSync Randomized Clinical Evaluation et al (2002) Cardiac resynchronization in chronic heart failure. N Engl J Med 346:1845–1853

    Article  PubMed  Google Scholar 

  8. Auricchio A, Stellbrink C, Sack S, Pacing Therapies in Congestive Heart Failure (PATH-CHF) Study Group et al (2002) Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J Am Coll Cardiol 39:2026–2033

    Article  PubMed  Google Scholar 

  9. Higgins SL, Hummel JD, Niazi IK et al (2003) Cardiac resynchronization therapy for the treatment of heart failure in patients with intraventricular conduction delay and malignant ventricular tachyarrhythmias. J Am Coll Cardiol 42:1454–1459

    Article  PubMed  Google Scholar 

  10. Young JB, Abraham WT, Smith AL, Multicenter InSync ICD Randomized Clinical Evaluation (MIRACLE ICD) Trial Investigators et al (2003) Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD trial. JAMA 289:2685–2694

    Article  PubMed  Google Scholar 

  11. Abraham WT, Young JB, Leon AR, Multicenter InSync ICD II Study Group et al (2004) Effects of cardiac resynchronization on disease progression in patients with left ventricular dysfunction, an indication for an implantable cardioverter-defibrillator, and mildly symptomatic heart failure. Circulation 110:2864–2868

    Article  PubMed  Google Scholar 

  12. Bristow MR, Saxon LA, Boehmer J, Comparison of Medical Therapy, Pacing, Defibrillation in Heart Failure (COMPANION) Investigators et al (2004) Cardiac resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 350:2140–2150

    Article  PubMed  CAS  Google Scholar 

  13. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L, Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators (2005) The effect of cardiac resynchronization therapy on morbidity and mortality in heart failure. N Eng J Med 352:1539–1549

    Article  CAS  Google Scholar 

  14. Bradley DJ, Bradley EA, Baughman KL, Berger RD, Calkins H, Goodman SN, Kass DA, Powe NR (2003) Cardiac resynchronization and death from progressive heart failure: a meta-analysis of randomized controlled trials. JAMA 289:730–740

    Article  PubMed  Google Scholar 

  15. McAlister EA, Ezekowitz JA, Wiebe N, Rowe B, Spooner C, Crumley E, Hartling L, Klassen T, Abraham W (2004) Systematic review: cardiac resynchronization in patients with symptomatic heart failure. Ann Intern Med 141:381–390

    PubMed  Google Scholar 

  16. Rivero-Ayersa R, Theuns D, Garcia–Garcia H, Boersma E, Simoons M, Jordaens LJ (2006) Effects of cardiac resynchronization therapy on overall mortality and mode of death: a meta-analysis of randomized controlled trials. Eur Heart J 27:2682–2688

    Article  Google Scholar 

  17. Linde C, Leclercq C, Rex S et al (2002) Long-term benefits of biventricular pacing in congestive heart failure: results from the MUltisite STimulation in cardiomyopathy (MUSTIC) study. J Am Coll Cardiol 40:111–118

    Article  PubMed  Google Scholar 

  18. St. John Sutton MG, Plappert T, Abraham WT, Multicenter InSync Randomized Clinical Evaluation (MIRACLE) Study Group et al (2003) Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure. Circulation 107:1985–1990

    Article  PubMed  Google Scholar 

  19. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L (2006) Longer-term effects of cardiac resynchronisation therapy on mortality in heart failure [the CArdiac REsynchronization-Heart Failure (CARE-HF) trial extension phase]. Eur Heart J 27:1928–1932

    Article  PubMed  Google Scholar 

  20. Bristow MR, Saxon LA, DeMarco T, Boehmer J, Galle E, Ecklund F, Feldman A (2005) What does an ICD add to CRT in advanced heart failure? An analysis of major clinical endpoints in the CRT vs CRT-D groups in the COMPANION trial. Circulation 112: II-673. Abstract

  21. Lindenfeld JA, Feldman AM, Saxon L et al (2007) Effects of cardiac resynchronization therapy with or without a defibrillator on survival and hospitalizations in patients with New York Heart Association class IV heart failure. Circulation 115:204–212

    Article  PubMed  Google Scholar 

  22. Vardas PE, Auricchio A, Blanc JJ, European Society of Cardiology; European Heart Rhythm Association et al (2007) Guidelines for cardiac pacing and cardiac resynchronization therapy: the Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European society of cardiology. Developed in collaboration with the European Heart Rhythm Association Eur Heart J 28:2256–2295

    Google Scholar 

  23. Epstein AE, DiMarco JP, Ellenbogen KA, American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices), American Association for Thoracic Surgery, Society of Thoracic Surgeons et al (2008) ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 117:e350–e408

    Article  PubMed  Google Scholar 

  24. Feldman AM, de Lissovoy G, Bristow MR et al (2005) Cost effectiveness of cardiac resynchronization therapy in the comparison of medical therapy, pacing, and defibrillation in heart failure (COMPANION) trial. J Am Coll Cardiol 46:2311–2321

    Article  PubMed  Google Scholar 

  25. Yao GL, Freemantle N, Calvert MJ, Bryan S, Daubert JC, Cleland JG (2007) The long-term cost-effectiveness of cardiac resynchronisation therapy with or without an implantable cardioverter-defibrillator. Eur Heart J 28:42–51

    Article  PubMed  CAS  Google Scholar 

  26. Kleeman T, Becker T, Doenges K, Vater M, Senges J, Schneider S, Saggau W, Weisse U, Seidl K (2007) Annual rate of transvenous defibrillation lead defects in implantable cardioverter-defibrillators over a period of >10 years. Circulation 115:2474–2480

    Article  Google Scholar 

  27. Maisel HM (2008) Semper fidelis-consumer protection for patients with implanted medical devices. N Engl J Med 358:985–987

    Article  PubMed  CAS  Google Scholar 

  28. Saxon LA, Bristow MR, Boehmer J et al (2006) Predictors of sudden cardiac death and appropriate shock in the comparison of medical therapy, pacing, and defibrillation in heart failure (COMPANION) Trial. Circulation 114:2766–2772

    Article  PubMed  Google Scholar 

  29. Poole JE, Johnson GW, Hellkamp AS et al (2008) Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med 359:1009–1017

    Article  PubMed  CAS  Google Scholar 

  30. Moss AJ, Hall WJ, MADIT-CRT Trial Investigators et al (2009) Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 361:1329–1338

    Article  PubMed  Google Scholar 

  31. Linde C, Abraham WT, Gold MR, St John Sutton M, Ghio S, Daubert C, REVERSE (REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction) Study Group (2008) Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. J Am Coll Cardiol 52:1834–1843

    Article  PubMed  Google Scholar 

  32. Packer M (2001) Proposal for a new clinical end point to evaluate the efficacy of drugs and devices in the treatment of chronic heart failure. J Card Fail 7:176–182

    Article  PubMed  CAS  Google Scholar 

  33. Daubert C, Gold MR, Abraham WT, Ghio S, Hassager C, Goode G, Szili-Török T, Linde C, Study Group REVERSE (2009) Prevention of disease progression by cardiac resynchronization therapy in patients with asymptomatic or mildly symptomatic left ventricular dysfunction: insights from the European cohort of the REVERSE (Resynchronization reverses remodeling in systolic left ventricular dysfunction) trial. J Am Coll Cardiol 54:1847–1849

    Article  Google Scholar 

  34. Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S, Hohnloser SH, Nichol G, Bimie DH, Sapp JL, Yee R, Healey JS, Rouleau J (2010) Cardiac resynchronization therapy for mild-to-moderate heart failure. N Engl J Med 363:2385–2395

    Article  PubMed  CAS  Google Scholar 

  35. Cohn JN, Ferrari R, Sharpe N (2000) Cardiac remodeling–concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling. J Am Coll Cardiol 35:569–582

    Article  PubMed  CAS  Google Scholar 

  36. Konstam MA, Kronenberg MW, Rousseau MF, Udelson JE, Melin J, Stewart D, Dolan N, Edens TR, Ahn S, Kinan D et al (1993) Effects of the angiotensin converting enzyme inhibitor enalapril on the long-term progression of left ventricular dilatation in patients with asymptomatic systolic dysfunction. SOLVD (studies of left ventricular dysfunction) investigators. Circulation 88:2277–2283

    Article  PubMed  CAS  Google Scholar 

  37. Bristow MR, Gilbert EM, Abraham WT, Adams KF, Fowler MB, Hershberger RE, Kubo SH, Narahara KA, Ingersoll H, Krueger S, Young S, Shusterman N (1996) Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. MOCHA investigators. Circulation 94:2807–2816

    Article  PubMed  CAS  Google Scholar 

  38. The SOLVD Investigattors (1992) Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. N Engl J Med 327:685–691

    Article  Google Scholar 

  39. Ghio S, Freemantle N, Scelsi L, Serio A, Magrini G, Pasotti M, Shankar A, Cleland JG, Tavazzi L (2009) Long term left ventricular reverse remodelling with cardiac resynchronization therapy: results from the CARE-HF trial. Eur J Heart Fail 11:480–488

    Article  PubMed  Google Scholar 

  40. Sutton MG, Plappert T, Hilpisch KE, Abraham WT, Hayes DL, Chinchoy E (2006) Sustained reverse left ventricular structural remodeling with cardiac resynchronization at one year is a function of etiology: quantitative Doppler echocardiographic evidence from the Multicenter InSync Randomized Clinical Evaluation (MIRACLE). Circulation 113:266–267

    Article  PubMed  Google Scholar 

  41. St John Sutton M, Ghio S, Plappert T, Tavazzi L, Scelsi L, Daubert C, Abraham WT, Gold MR, Hassager C, Herre JM, Linde C, Esynchronization R, REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction (REVERSE) Study Group (2009) Cardiac resynchronization induces major structural and functional reverse remodeling in patients with New York Heart Association class I/II heart failure. Circulation 120:1858–1865

    Article  PubMed  Google Scholar 

  42. Solomon SD, Foster E, Bourgoun M, Shah A, Viloria E, Brown MW, Hall WJ, Pfeffer M, Moss AJ (2010) Effect of cardiac resynchronization therapy on reverse remodelling and relation to outcome. Circulation 122:985–992

    Article  PubMed  Google Scholar 

  43. Di Biase L, Gasparini M, Lunati M, Santini M, Landolina M, Boriani G, Curnis A, Bocchiardo M, Vincenti A, Denaro A, Valsecchi S, Natale A, Padeletti L, InSync/InSync ICD Italian Registry Investigators (2008) Antiarrhythmic effect of reverse ventricular remodeling induced by cardiac resynchronization therapy: the InSync ICD (implantable cardioverter-defibrillator) Italian registry. J Am Coll Cardiol 52:1442–1449

    Article  PubMed  Google Scholar 

  44. Dickstein K, Vardas P, Auricchio A, Daubert C, Linde C, Mc Murray J, Ponikowski P, Priori SG, Sutton R, van Veldhuisen DJ (2010) Focused Update of ESC Guidelines on device therapy in heart failure Eur Heart J 31:2677–2687

    Google Scholar 

  45. Komajda M, Follath F, Swedberg K, Cleland J, Aguilar JC, Cohen-Solal A, Dietz R, Gavazzi A, Van Gilst WH, Hobbs R, Korewicki J, Madeira HC, Moiseyev VS, Preda I, Widimsky J, Freemantle N, Eastaugh J, Mason J, Study Group on Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology (2003) The EuroHeart Failure Survey programme–a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment. Eur Heart J 24:464–474

    Article  PubMed  CAS  Google Scholar 

  46. Dickstein K, Bogale N, Priori S, Auricchio A, Cleland JG, Gitt A, Limbourg T, Linde C, van Veldhuisen DJ, Brugada J, Scientific Committee, National Coordinators (2009) The European cardiac resynchronization therapy survey. Eur Heart J 30:2450–2460

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service de cardiologie et maladies vasculaires, Hôpital Pontchaillou-CHU, 35033, Rennes, France

    Jean-Claude Daubert & Erwan Donal

  2. Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden

    Cecilia Linde

Authors
  1. Jean-Claude Daubert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erwan Donal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cecilia Linde
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jean-Claude Daubert.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Daubert, JC., Donal, E. & Linde, C. A plea for the wider use of CRT-P in candidates for cardiac resynchronisation therapy. Heart Fail Rev 17, 767–775 (2012). https://doi.org/10.1007/s10741-011-9277-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10741-011-9277-8

Keywords

Search

Navigation