Prof Auricchio showed compelling data from the MILOS study examining the use of CRT in AF patients. It is apparent that Av nodal ablation is required in the majority of cases to ensure optimal benefit from CRT. In the group with a pace and ablate strategy symptomatic improvement, reversed remodelling and survival were comparable or better than in the SR group receiving CRT.
Whilst current trials have generally recruited patients younger than the normal heart failure population, Dr Lamp observed the potential needs and benefits of CRT in the more elderly group. On reviewing the data from the Italian registry and her own data from Bad Oeynhausen, Dr Lamp showed that the symptomatic benefit was equal in the elderly group compared with the younger population. The impact on survival was less marked as would be expected provoking a discussion on the appropriatness of CRT-D in this population.
The role of CRT-D v CRT-P was taken up by Dr Lozano. He showed that whilst no formal study has adequately addressed the issue the weight of evidence supports the additional benefit of the combined device.
Prof Blanc reviewed the potentially deleterious effect of right ventricular pacing on ventricular function and summarised the trials so far on upgrading existing devices. Although there is no randomised data the general opinion remains that in those with deteriorating function up grade to CRT should be considered.
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