Cardiac Resynchronization Therapy With or Without Defibrillator in Nonischemic Cardiomyopathy: Evidence Synthesis and Clinical Implications from DECIDE-CRT and Related Studies

Highlights

• The DECIDE-CRT nationwide cohort study found no statistically significant survival advantage of adding a defibrillator (CRT-D) over CRT pacing alone (CRT-P) in patients with nonischemic cardiomyopathy (NICM) over 5 years.
• Meta-analyses and randomized trial subanalyses show mixed results—with some evidence suggesting CRT-D reduces all-cause mortality especially in younger NICM patients, though benefits attenuate in older populations.
• Emerging risk stratification tools, including cardiac magnetic resonance (CMR) scar imaging and periodic repolarization dynamics (PRD), help identify NICM patients more likely to benefit from ICD therapy.
• Sex-specific and etiology-dependent differences affect arrhythmic risk and device efficacy, underscoring personalized approaches in device selection for NICM patients.