title: Benefit of combined resynchronization and defibrillator therapy in heart failure patients with and without ventricular arrhythmias.
abstract: OBJECTIVE
  We attempted to assess the efficacy of combined cardiac resynchronization therapy-implantable cardioverter-defibrillator (CRT-ICD) in heart failure patients with and without ventricular arrhythmias.
  
  
  BACKGROUND
  Because CRT and ICDs both lower all-cause mortality in patients with advanced heart failure, combination of both therapies in a single device is challenging.
  
  
  METHODS
  A total of 191 consecutive patients with advanced heart failure, left ventricular ejection fraction <35%, and a QRS duration >120 ms received CRT-ICD. Seventy-one patients had a history of ventricular arrhythmias (secondary prevention); 120 patients did not have prior ventricular arrhythmias (primary prevention). During follow-up, ICD therapy rate, clinical improvement after 6 months, and mortality rate were evaluated.
  
  
  RESULTS
  During follow-up (18 +/- 4 months), primary prevention patients experienced less appropriate ICD therapies than secondary prevention patients (21% vs. 35%, p < 0.05). Multivariate analysis revealed, however, no predictors of ICD therapy. Furthermore, a similar, significant, improvement in clinical parameters was observed at 6 months in both groups. Also, the mortality rate in the primary prevention group was lower than in the secondary prevention group (3% vs. 18%, p < 0.05).
  
  
  CONCLUSIONS
  As 21% of the primary prevention patients and 35% of the secondary prevention patients experienced appropriate ICD therapy within 2 years after implant, and no predictors of ICD therapy could be identified, implantation of a CRT-ICD device should be considered in all patients eligible for CRT.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ypenburg
authors.forename: Lieselot
authors.initials: L
authors.lastname: van Erven
authors.forename: Gabe B
authors.initials: GB
authors.lastname: Bleeker
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Marianne
authors.initials: M
authors.lastname: Bootsma
authors.forename: Maurits C
authors.initials: MC
authors.lastname: Wijffels
authors.forename: Ernst E
authors.initials: EE
authors.lastname: van der Wall
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Schalij
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D002303:Cardiac Output, Low / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D019564:Unnecessary Procedures