Implantable cardioverter-defibrillators with or without cardiac resynchronization therapy - multiple therapy in a single device: a review with special reference to the PACMAN study

Patients with heart failure and ventricular conduction disturbance benefit haemodynamically from cardiac resynchronization therapy (CRT), but reduced mortality with CRT has not been demonstrated. The implantable cardioverter-defibrillator (ICD) reduced sudden death, which accounts for more than 50% of heart failure mortality. This review focuses on data from trials on ICD and CRT treatment in heart failure patients. The design of one study - the Pacing in Cardiomyopathies, a European Study (PACMAN) - is presented. Current recruitment in this trial indicates that 30% of patients receiving CRT require ICD backup. Ongoing larger trials will determine the true benefit of ICD and CRT in heart failure patients.