Cardiac Resynchronization Therapy: Current State of the Art. Cost Versus Benefit

Abstract

The Table summarizes many of the known effects induced by CRT. These responses have, for the most part, been documented in highly symptomatic heart failure patients who have dilated cardiomyopathy regardless of etiology with depressed systolic function and a QRS duration ≥120 ms. Conclusive cost-effectiveness data are not yet available. Whether or not heart failure patients should be implanted with a CRT-D device versus CRT alone remains debatable. The COMPANION trial results suggest that CRT-D provides incremental benefit for survival. Finally, there is a large heterogeneous group of patients (those with atrial fibrillation, previously implanted pacemakers with or without prior His-bundle ablation, prior previous valve surgery, etc) who have been treated "off-label" with CRT in whom no controlled data are yet available to justify treatment with this device.