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AHA: ICD-CRT Linked to Less Death, Hospitalization

But versus ICD alone, the combination is tied to more adverse events in some heart failure patients

MONDAY, Nov. 15 (HealthDay News) -- In a certain group of heart failure patients, adding cardiac-resynchronization therapy (CRT) to an implantable cardioverter-defibrillator (ICD) appears to reduce rates of death and hospitalization for heart failure but raises the risk of adverse events, according to a study published online Nov. 14 in the New England Journal of Medicine to coincide with presentation at the American Heart Association's Scientific Sessions 2010, held from Nov. 13 to 17 in Chicago.

Anthony S.L. Tang, M.D., of the University of British Columbia in Vancouver, Canada, and colleagues randomized 1,798 patients with New York Heart Association class II or III heart failure, a left ventricular ejection fraction of 30 percent or lower, and an intrinsic QRS duration of 120 msec or more or a paced QRS duration of 200 msec or more to receive either an ICD plus CRT or an ICD only.

The investigators found that death from any cause or hospitalization for heart failure occurred in 33.2 percent who received an ICD plus CRT and 40.3 percent who received an ICD only. The investigators also found that 186 patients who received an ICD plus CRT died compared to 236 who received an ICD alone (hazard ratio 0.75). Adverse events at 30 days after device implantation occurred in 124 patients who received an ICD plus CRT compared with 58 patients who received an ICD only.

"Despite the positive findings, it should be appreciated that device- or implant-related complications and device-related hospitalizations during follow-up were twice as frequent in the ICD-CRT group as in the ICD group," writes the author of an accompanying editorial.

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