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Cardiac resynchronization therapy (CRT) improves outcomes in patients with moderate or severe (New York Heart Association class III or IV) heart failure (HF) and a wide QRS complex. In patients with less-severe HF, CRT is associated with a reduction in left ventricular remodeling and an improvement in the composite of HF events and death (JW Cardiol Sep 1 2009). However, the composite outcome was driven by a reduction in HF events, so the mortality benefit of CRT, especially in implantable cardioverter-defibrillator (ICD) recipients, has remained uncertain.
In this international, manufacturer-supported trial, 1798 patients with standard indications for ICD placement, NYHA class II or III HF (80%, class II), and QRS duration >120 milliseconds…