Downgrade from CRT-D to CRT-P at time of generator replacement: a true clinical conundrum or just an academic debate?

Excerpt

Cardiac resynchronization therapy (CRT) is a well-established therapy for patients with symptomatic heart failure, left ventricular (LV) dysfunction, and a prolonged QRS [1]. CRT induced reverse remodeling can improve quality of life and the risk of heart failure hospitalizations and death. CRT with a defibrillator (CRT-D) has additionally been shown to reduce the risk of ICD therapies compared to ICD alone, and importantly CRT pacemakers reduce the risk of sudden death compared to medical therapy [2‐4]. However, the majority of patients who receive a CRT-D have a primary prevention ICD indication. Approximately 80% patients with a CRT-D will not experience a ventricular arrhythmic event (VAE) during the lifetime of their first device and have a lower risk for inappropriate and appropriate ICD therapies compared to their non-CRT ICD counterparts [5, 6]. …