EFFICACY AND SAFETY OF TREATMENT OF PATIENTS WITH CHRONIC HEART FAILURE USING CRT-D AND ICD: RESULTS OF A RANDOMIZED TRIAL

Goal. To evaluate the efficacy and safety of cardioresynchronization therapy with defibrillation (CRT-D) in comparison with implantable cardioverter defibrillator (ICD) in patients with heart failure and reduced left ventricular ejection fraction. Materials and methods. The study was conducted at the Dagestan Center of Cardiology and Cardiovascular Surgery and included 30 patients randomly divided into two groups: CRT-D (n=14) and ICD (n=16). Patients over 18 years of age with a left ventricular ejection fraction < 35% and a wide QRS complex (≥150 ms) were included. Primary and secondary clinical outcomes were analyzed using various statistical approaches. Results. CRT-D resulted in a significant decrease in the combined mortality and hospitalization rate (adjusted OR 0.13; 95% CI 0.07–0.21; P <0.001), as well as an improvement in morphological and functional parameters of the left ventricle compared with ICD. The complication rate was similar in both groups, but the incidence of serious ventricular arrhythmias was significantly lower in the CRT-D group [0.6% vs. 13.8% in the ICD group]. Conclusions. The results of our study support the benefits of CRT-D in patients with heart failure and reduced ejection fraction, demonstrating improved clinical outcomes and reduced frequency of arrhythmias. These data highlight the importance of an individualized approach in choosing therapy for patients with heart failure.