Cardiac resynchronization pacing without defibrillator capability: is this a viable option?

Improved cardiac resynchronization by pacemakers (CRT-P) and implantable defibrillators (CRT-D) benefits cardiac function, reduces heart failure (HF) admissions, and diminishes mortality in patients with severe left ventricular (LV) dysfunction. In terms of mortality benefit, current evidence suggests that CRT-D may be better than CRT-P alone when a broad range of HF patients is considered. However, the differential benefit may be small in certain patients. In individuals with severe and worsening HF due to systolic LV dysfunction, HF complications other than ventricular tachyarrhythmias contribute importantly to both quality-of-life (QoL) and duration of survival; these patients may be served cost-effectively by CRT-P enhancing QoL. A clinical trial evaluating CRT-D vs. CRT-P in terms of QoL and survival in such patients would assist physicians and payers to understand better the relative roles of CRT-P and CRT-D in the care of the sickest HF patients.