Cardiac Resynchronization Therapy in Heart Failure
Authors: Melanie Calvert, Nick Freemantle, John G.F. Cleland
Journal: Annals of Internal Medicine (2005)

Letters15 February 2005Cardiac Resynchronization Therapy in Heart FailureMelanie Calvert, PhD, Nick Freemantle, PhD, and John G.F. Cleland, MDMelanie Calvert, PhDFrom University of Birmingham Medical School, Edgbaston B15 2TT, and University of Hull, Kingston upon Hull HU16 5JQ, England, United Kingdom.Search for more papers by this author, Nick Freemantle, PhDFrom University of Birmingham Medical School, Edgbaston B15 2TT, and University of Hull, Kingston upon Hull HU16 5JQ, England, United Kingdom.Search for more papers by this author, and John G.F. Cleland, MDFrom University of Birmingham Medical School, Edgbaston B15 2TT, and University of Hull, Kingston upon Hull HU16 5JQ, England, United Kingdom.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-142-4-200502150-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:McAlister and colleagues (1) concluded that in selected patients with heart failure, CRT improves functional and hemodynamic status, reduces heart failure hospitalizations, and reduces all-cause mortality. Such conclusions, however, are unsafe and are based on incorrect presentation of the existing scientific data.A major problem with McAlister and colleagues' analysis is that it does not deal appropriately with potential differences in the efficacy of CRT delivered with or without an ICD. Of particular concern is the presentation of the all-cause mortality data from the COMPANION trial, which fails to preserve randomization. This ignores a basic tenet of ...References1. McAlister FA, Ezekowitz JA, Wiebe N, Rowe B, Spooner C, Crumley E, et al. Systematic review: cardiac resynchronization in patients with symptomatic heart failure. Ann Intern Med. 2004;141:381-90. [PMID: 15353430] LinkGoogle Scholar2. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350:2140-50. [PMID: 15152059] CrossrefMedlineGoogle Scholar3. Egger M, Davey Smith G, Altman D. Systematic Reviews in Health Care: Meta-Analysis in Context. London: BMJ Publishing Group; 2001. Google Scholar4. Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, et al. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med. 2001;344:873-80. [PMID: 11259720] CrossrefMedlineGoogle Scholar5. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002;346:1845-53. [PMID: 12063368] CrossrefMedlineGoogle Scholar6. Young JB, Abraham WT, Smith AL, Leon AR, Lieberman R, Wilkoff B, et al. Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. JAMA. 2003;289:2685-94. [PMID: 12771115] CrossrefMedlineGoogle Scholar7. Auricchio A, Stellbrink C, Sack S, Block M, Vogt J, Bakker P, et al. Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J Am Coll Cardiol. 2002;39:2026-33. [PMID: 12084604] CrossrefMedlineGoogle Scholar8. Garrigue S, Bordachar P, Reuter S, Jais P, Kobeissi A, Gaggini G, et al. Comparison of permanent left ventricular and biventricular pacing in patients with heart failure and chronic atrial fibrillation: prospective haemodynamic study. Heart. 2002;87:529-34. [PMID: 12010933] CrossrefMedlineGoogle Scholar9. Leclercq C, Walker S, Linde C, Clementy J, Marshall AJ, Ritter P, et al. Comparative effects of permanent biventricular and right-univentricular pacing in heart failure patients with chronic atrial fibrillation. Eur Heart J. 2002;23:1780-7. [PMID: 12419298] CrossrefMedlineGoogle Scholar10. Leclerq C, Cazeau S, Lellouche D, et al. Upgrading from right ventricular pacing to biventricular pacing in previously paced patients with advanced heart failure: a randomized, controlled study (the RD-CHF Trial) [Abstract]. Presented at the European Society of Cardiology Congress, Vienna, Austria, 30 August–3 September 2003. Google Scholar11. Higgins SL, Hummel JD, Niazi IK, Giudici MC, Worley SJ, Saxon LA, et al. Cardiac resynchronization therapy for the treatment of heart failure in patients with intraventricular conduction delay and malignant ventricular tachyarrhythmias. J Am Coll Cardiol. 2003;42:1454-9. [PMID: 14563591] CrossrefMedlineGoogle Scholar12. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The CARE-HF study (CArdiac REsynchronisation in Heart Failure study): rationale, design and end-points. Eur J Heart Fail. 2001;3:481-9. [PMID: 11511435] CrossrefMedlineGoogle Scholar13. Leclercq C, Kass DA. Retiming the failing heart: principles and current clinical status of cardiac resynchronization. J Am Coll Cardiol. 2002;39:194-201. [PMID: 11788207] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Birmingham Medical School, Edgbaston B15 2TT, and University of Hull, Kingston upon Hull HU16 5JQ, England, United Kingdom.Note: Drs. Freemantle and Cleland are steering committee members for the CArdiac REsynchronisation in Heart Failure (CARE-HF) trial. Drs. Freemantle and Calvert are responsible for the analysis of the CARE-HF trial. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSystematic Review: Cardiac Resynchronization in Patients with Symptomatic Heart Failure Finlay A. McAlister , Justin A. Ezekowitz , Natasha Wiebe , Brian Rowe , Carol Spooner , Ellen Crumley , Lisa Hartling , Terry Klassen , and William Abraham Cardiac Resynchronization Therapy in Heart Failure Finlay A. McAlister , Natasha Wiebe , and William Abraham Cardiac Resynchronization Therapy in Heart Failure Enrique V. Carbajal , Grace W. Huang , and Billy Hu Metrics Cited byCaudocranial transseptal approach for placement of endocardial left ventricular leadsSurgically placed left ventricular leads provide similar outcomes to percutaneous leads in patients with failed coronary sinus lead placementImplantation of cardiac resynchronization therapy systems in the CARE-HF trial: procedural success rate and safetyEffects of Stimulation Site on Diastolic Function in Cardiac Resynchronization TherapyCardiac resynchronisation for patients with heart failure due to left ventricular systolic dysfunction - a systematic review and meta-analysisImpact of Implantable Defibrillators and Resynchronization Therapy on Outcome in Patients with Left Ventricular Dysfunction – A Meta-AnalysisCost-effectiveness of cardiac resynchronization therapy: results from the CARE-HF trialThe Effect of Cardiac Resynchronization on Morbidity and Mortality in Heart FailureImpact of CRT on Mortality: What Are the Preliminary Results from the CARE-HF Trial? 15 February 2005Volume 142, Issue 4Page: 305-307KeywordsExerciseHeart failureHemodynamicsHospitalizationsMorbiditySafetyStatistical data ePublished: 15 February 2005 Issue Published: 15 February 2005 Copyright & PermissionsCopyright © 2005 by American College of Physicians. 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