The efficacy and safety of cardiac resynchronization therapy combined with implantable cardioverter defibrillator for heart failure: a meta-analysis of 5674 patients

AIMS: The purpose of this study was to evaluate the efficacy and safety of cardiac resynchronization plus implantable cardioverter defibrillator (CRT-D) therapy and implantable cardioverter defibrillator (ICD) therapy in treating heart failure by systematically reviewing randomized controlled trials. METHODS AND RESULTS: Databases of Medline, Embase, and Cochrane Library were searched for published studies up to 31 May 2012. Clinicaltrials.gov and US Food and Drug Administration websites were searched as well. Only randomized controlled trials comparing the efficacy of CRT-D therapy with ICD therapy were enrolled in meta-analysis. Eight randomized controlled trials characterizing 5674 patients were finally included. Meta-analysis found that CRT-D therapy was associated with significant improvement in clinical conditions [odds ratio (OR): 1.66; 95% confidence interval (CI):1.33-2.07] and a reduction in hospitalization (OR: 0.7; 95% CI: 0.6-0.81) and all-cause mortality (OR: 0.8; 95% CI: 0.67-0.95). Although advantages of CRT-D therapy over ICD therapy were obvious, the peri-implantation adverse events of CRT-D therapy remained to be concerns. CONCLUSION: Compared with ICD therapy, patients receiving CRT-D therapy have favourable outcomes regarding improvement in clinical conditions, hospitalization rate, and overall survival, but at a significantly higher risk of peri-implantation adverse events. Future studies are warranted to optimize the clinical application of CRT-D.