title: Cardiac resynchronization therapy-defibrillator improves long-term survival compared with cardiac resynchronization therapy-pacemaker in patients with a class IA indication for cardiac resynchronization therapy: data from the Contak Italian Registry.
abstract: OBJECTIVE
  In candidates for cardiac resynchronization therapy (CRT), the choice between pacemaker (CRT-P) and defibrillator (CRT-D) implantation is still debated. We compared the long-term prognosis of patients who received CRT-D or CRT-P according to class IA recommendations of the European Society of Cardiology (ESC) and who were enrolled in a multicentre prospective registry.
  
  
  RESULTS
  A total of 620 heart failure patients underwent successful implantation of a CRT device and were enrolled in the Contak Italian Registry. This analysis included 266 patients who received a CRT-D and 108 who received a CRT-P according to class IA ESC indications. Their survival status was verified after a median follow-up of 55 months. During follow-up, 73 CRT-D and 44 CRT-P patients died (rate 6.6 vs. 10.4%/year; log-rank test, P = 0.020). Patients receiving CRT-P were predominantly older, female, had no history of life-threatening ventricular arrhythmias, and more frequently presented non-ischaemic aetiology of heart failure, longer QRS durations, and worse renal function. However, the only independent predictor of death from any cause was the use of CRT-P (hazard ratio, 1.97; 95% confidence interval, 1.21-3.16; P = 0.007).
  
  
  CONCLUSIONS
  The implantation of CRT-D, rather than CRT-P, may be preferable in patients presenting with current class IA ESC indications for CRT. Indeed, CRT-D resulted in greater long-term survival and was independently associated with a better prognosis.
authors: Ospedale Civile Maggiore di Borgo Trento, Verona, Italy.
authors: Giovanni
authors: G
authors: Morani
authors: Maurizio
authors: M
authors: Gasparini
authors: Francesco
authors: F
authors: Zanon
authors: Edoardo
authors: E
authors: Casali
authors: Alfredo
authors: A
authors: Spotti
authors: Albino
authors: A
authors: Reggiani
authors: Emanuele
authors: E
authors: Bertaglia
authors: Francesco
authors: F
authors: Solimene
authors: Giulio
authors: G
authors: Molon
authors: Michele
authors: M
authors: Accogli
authors: Corrado
authors: C
authors: Tommasi
authors: Alessandro
authors: A
authors: Paoletti Perini
authors: Carmine
authors: C
authors: Ciardiello
authors: Luigi
authors: L
authors: Padeletti
mesh_terms: D017677:Age Distribution; D058406:Cardiac Resynchronization Therapy / Q000401:mortality*; D058409:Cardiac Resynchronization Therapy Devices / Q000706:statistics & numerical data*; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D018572:Disease-Free Survival; D004554:Electric Countershock / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Cardiac resynchronization therapy; Heart Failure; ICD; Mortality; Pacemaker