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Eva is a cheerful 76-year-old Norwegian woman with 5 grandchildren who had an anterior myocardial infarction 8 years ago and subsequently underwent coronary artery bypass grafting for triple-vessel disease. Over the last several years, she developed heart failure as the result of ischemic cardiomyopathy and became increasingly symptomatic. Until 1 year ago, she was reasonably active but has become short of breath on mild exertion, with New York Heart Association (NYHA) Class III symptoms. She does not have angina. We had an unusually cold winter this year, and she was unable to walk in the snow and was once hospitalized for an episode of decompensation with dyspnea at rest. There is consistency across the European and American guidelines1–5 in providing the Class I recommendation level with level of evidence A for cardiac resynchronization therapy (CRT) for patients with heart failure, New York Heart Association class functional Class III-IV symptoms, left ventricular dysfunction, and a wide QRS complex. I was surprised to read that Dr Coceani is not convinced that CRT deserves this strong recommendation for patients with these conventional criteria.5 Well-founded skepticism is to be admired. However, in this case it is undeserved. The evidence is irrefutable. In CARE-HF, which found a 40% relative risk reduction in the primary end point of all-cause death or cardiovascular hospitalization and a 52% reduction in heart failure hospitalizations, the number needed to treat to prevent a primary end point was 9.6 In cardiovascular medicine, it is unusual to demonstrate such powerful intervention strategies.It is …

Response to Coceani: Cardiac Resynchronization Therapy Has Earned Its Class I Recommendation and Continues to Thrive Under Scrutiny