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Heart failure (HF) is common and associated with considerable mortality and morbidity and decline in quality of life. Since the beginning of this century, cardiac resynchronisation therapy (CRT) has emerged as a new modality to treat patients with HF already on optimal pharmacological treatment. A systematic review of major clinical trials found that CRT, when added to medical treatment, reduces morbidity and mortality in HF patients who have a left ventricular ejection fraction (LVEF) less than 35%, sinus rhythm, QRS>120 ms and advanced HF symptoms.1 Until recently, the efficacy of CRT in less symptomatic HF patients remained the major unanswered question in this field; the Resynchronization/Defibrillation for Ambulatory Heart Failure Trial (RAFT) addressed this specific question.
This was a multicentre, parallel, blinded (patients, healthcare providers and adjudication committee) and randomised controlled trial. The population was HF patients on optimal medical therapy with LVEF <30%, intrinsic QRS >120 ms or paced QRS >200 ms, sinus rhythm or atrial fibrillation (AF) and New York Heart Association (NYHA) functional class II or III despite optimal medical treatment. The protocol was subsequently modified in 2006 to include only patients with NYHA class II. All participants met standard criteria for implantable cardioverter defibrillator (ICD). Before device implantation, patients were randomised to either CRT+ICD (intervention) or ICD …
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