November 14th, 2010
ICD-CRT Found Beneficial in RAFT
RAFT (Resynchronization-Defibrillation for Ambulatory Heart Failure Trial) randomized 1798 patients with NYHA class II or III heart failure, LVEF < 30%, and a wide QRS complex to either an ICD alone or an ICD-CRT. After a mean followup of 40 months, the rate of death or heart failure hospitalization was 40.3% in the ICD group compared to 33.2% in the ICD-CRT group (p<0.001) and overall mortality rates were 26.1% and 20.8%, respectively (p<0.003). There were more adverse events in the ICD-CRT group, however (124 versus 58 in the placebo group at 30 days). As in the MADIT-CRT trial, an increased benefit was observed in patients with QRS durations of 150 msec or more.
RAFT was presented at the AHA meeting in Chicago and published online simultaneously in the New England Journal of Medicine. Speculating about why RAFT, unlike MADIT-CRT, was able to show a survival benefit, the RAFT investigators pointed out that RAFT patients were sicker than their MADIT-CRT counterparts and underwent a longer and more complete followup.
In an accompanying editorial, Arthur Moss writes that three trials (MADIT-CRT, RAFT, and REVERSE) now provide “convincing evidence of the therapeutic prowess of CRT in appropriately selected patients with ischemic or nonischemic cardiomyopathy.”
Note: In an accompanying post on CardioExchange, Moss sheds additional light on the role of LBBB, QRS duration, and women in RAFT.