What is the level of evidence for combined cardiac resynchronization and defibrillation therapy in heart failure? reply

Le résumé fourni par la source

In the letter, Doctors Lam and Owen offer some very relevant comments on the recommendations for cardiac resynchronization combined with defibrillation therapy (CRT-D) in the ESC guidelines.1 In regard to point 3.2.1, the authors provide further evidence from a network meta-analysis2 grouping randomized controlled trials on device therapy in heart failure (HF) and its effects on death from any cause. This meta-analysis observed a significant reduction in deaths of any cause (Odds ratio 0.57, 95% confidence interval 0.40–0.80) conferred by CRT-D compared with medical therapy. This recent contribution was not available at the time of publication of these guidelines and it strengthens further the indication for CRT-D. In relation to the second point, the recommendation of section 3.2.3, is addressed to patients fulfilling the conventional indication for CRT and who present a concomitant Class I indication for the implantation of an ICD. This includes not only primary prevention, but also secondary prevention such as cardiac arrest survivors or patients with documented sustained ventricular tachycardia: it is clear that, in these cases, a CRT-P device is not adequate, and a CRT-D device is compulsory. Even considering primary prevention of SCD,3 the current recommendations indicate (class I) the use of an ICD in HF patients with LV impairment. This statement could not be neglected by the CRT guidelines. For these reasons, the consensus was that a class I recommendation should be given.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.