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

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.