The Meta-analysis Of Cardiac Resynchronization Therapy Plus Implantable Cardioverter Defibrillator In Patients With Heart Failure

Objective: Cardiac resynchronization therapy plus implantablecardioverter defibrillator (CRT-D) therapy is a new technique in thetreatment of chronic heart failure. Implantable cardioverter defibrillator(ICD) therapy can reduce the risk of sudden cardiac death of heart failurepatients. The aim of this study is to investigate the role of CRT-D therapy onthe improvement of clinical status and rehospitalization rate as relative toICD therapy for patients with heart failure.Methods: Meta-analysis was conducted by searching the database ofMedline, Embase, The Cochrane Library, and US Food and DrugAdministration website for published studies up to31October2012.The endpoint of the study is CRT-D and ICD therpy for heart failure improvementof clinical status and rehospitalization rate.Results: Six randomized controlled trials（RCTs）(n=5273) wereincluded. All patients enrolled underwent drug treatment recommending heart failure guidelines.Overall, the clinical status of patients in CRT-Dgroup was significantly improved as compared with that in ICDgroup(P<0.01),meanwhile, the rehospitalization rate in CRT-D group wassignificantly decreased（P<0.01）. In New York Heart Association (NYHA)class I-II patients,the superiority of clinical status in CRT-D group was notapparen（tWMD：0.19；95%CI：-3.89~4.72）,however,it seemed to be moresignicant improved（P<0.001） in NYHA class III-IV. In NYHA classI-II,the rehospitalization rate in CRT-D group was still significantly（P<0.01）,but in NYHA class III-IV,which follow-up was only6months,there was no significant difference between them（P>0.05）.Conclusions: Compared with ICD therapy, CRT-D therapy canimprove the patients’clinical status and reduce the rehospitalilaztion rate inpatients with heart failure on the basis of pharmacotherapy.