AHA: CRT Plus ICD Reduces Mortality in Mild Heart Failure

Dr. Yancy, who took part in the Food and Drug Administration review of the MADIT-CRT trial, responded that there was a compelling signal in MADIT-CRT for the use of CRT plus ICD among patients with left bundle branch block.

"There was nearly an 85% greater efficacy when CRT was applied to that population, and now we see the signal again," he said. "If we are not to have further studies, I think we have to revisit both the prolongation of QRS and left block bundle pattern and understand that there may in fact be a greater likelihood of benefit with those two substrates."

The invited discussant, Dr. Eugene Braunwald, Distinguished Hersey Professor of Medicine at Harvard Medical School in Boston, observed that the use of CRT is moving further down in less sick patients as long as they have QRS prolongation. "Where do you think this is going? ... Are you thinking of patients with [NYHA] class I or II, with better ejection fractions?" he asked.

Dr. Tang responded that clinicians need to treat patients earlier in the disease process to prevent problems, but that it remains to be seen whether CRT-ICD therapy, like beta-blockade, can be used early on.

The RAFT data were simultaneously published online by the New England Journal of Medicine (2010;10.1056/NEJM0a1009540).

RAFT was funded by the Canadian Institutes of Health Research and Medtronic of Canada. Dr. Tang disclosed research support from Boston Scientific, Medtronic, and St. Jude Medical. Dr. Yancy reported having no financial conflicts of interest.