Cardiac resynchronization therapy for mild-to-moderate heart failure

Abstract

Cardiac resynchronization therapy (CRT) is recognized as a class I indication according to American and European practice guidelines since 2005 in selected patients with systolic heart failure and New York Heart Association (NYHA) III/IV symptoms. There is growing evidence that CRT may also benefit patients who are less symptomatic, as it may delay or even reverse the disease process. In the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT), Tang et al. randomized 1798 patients with left ventricular ejection fraction of ≤ 30%, QRS duration of ≥ 120 ms (or paced QRS ≥ 200 ms), and NYHA class II or III heart failure to receive an implantable cardioverter-defibrillator (ICD) or an ICD-CRT. After a mean follow-up of 40 months, there was a 25% relative reduction both in the primary outcome of death or heart failure hospitalization (p < 0.001), as well as in the secondary outcome of total mortality (p = 0.003). This landmark trial adds evidence to the efficacy of CRT in selected patients with mild-to-moderate heart failure, at the time of implementation of new guidelines.