http://www.theheart.org/web_slides/1185801.do A study on Resynchronization/Defibrillation for Ambulatory Heart Failure (RAFT) that determine whether the addition of cardiac resynchronization therapy (CRT) to optimal pharmacological therapy and implantable cardioverter-defibrillator (ICD) is effective in reducing mortality and morbidity in patients with moderate HF

1. RAFT (Resynchronization/Defibrillation
for Ambulatory Heart Failure Trial)

2. RAFT (Resynchronization/Defibrillation for
Ambulatory Heart Failure Trial)
A Tang (University of Ottawa Heart Institute, ON)
American Heart Association 2010 Scientific Sessions
• Objective:
Determine whether the addition of cardiac resynchronization therapy (CRT) to
optimal pharmacological therapy and implantable cardioverter-defibrillator (ICD)
is effective in reducing mortality and morbidity in patients with moderate HF
• Population and treatment:
1798 patients with NYHA class 2 or 3 HF, LVEF <30%, and a QRS duration
>120 ms (or paced QRS >200 ms)
Randomized to ICD therapy alone or an ICD with CRT (CRT-D)—40-month
mean follow-up
• Primary outcome:
All-cause death or HF hospitalization

3. RAFT: Results
Adding CRT to ICD therapy improved survival in this patient population
• The primary outcome occurred in 33.2% of the CRT-D group and 40.3% of the
ICD-only group (HR 0.75, p<0.001)
• By the last follow-up, 186 out of the 894 CRT-D patients died compared with 236 of
the 904 patients in the ICD-alone group
• The five-year actuarial death rates were 28.6% for the CRT-D group vs 34.6% for
the ICD-alone group (HR 0.75, p=0.003)
• There were 174 HF hospitalizations in the CRT-D group and 236 in the ICD-alone
group
• There were 118 device- or implantation-related periprocedural complications in the
CRT-D group vs 61 in the ICD-alone group, but no complication-related fatalities

4. RAFT: Commentary*
"This is the important randomized clinical-trial evidence that we needed."
- Dr Greg Fonarow
"We may ultimately need to revisit which thresholds we recommend that should
trigger the indication for CRT."
- Dr Clyde Yancy
"[CRT] causes neurohormonal remodeling, decreases the sympathetic tone, and
decreases the downregulation of beta receptors into the heart. It really causes
molecular repair, but you have to have some kind of electrical issue to trigger that
effect."
- Dr Leslie Saxon
*All comments from CRT is a lifeRAFT for class 2 and 3 HF patients with low EF and wide QRS
(http://www.theheart.org/article/1147233.do)

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