OBJECTIVETo evaluate the efficacy and safety of percutaneous coronary intervention (PCI) combined cardiac resynchronization therapy (CRT) for refractory heart failure secondary to ischemic cardiomyopathy (ICM).

METHODSPCI and CRT were performed in 7 ICM patients confirmed by angiography with NYHA class IV, QRS duration >/= 130 ms in 6 of them, III degrees AVB in 1 patient, fast ventricular heart rate Af in 1 patient, ventricular fibrillation history in 2 patient. All of them had their LVEDD >/= 55 mm, and LVEF

RESULTSThe procedures of PCI and CRT were performed successfully in all patients. Five patients received right atrial and biventricular pacing, one patient with Af received biventricular pacing and atrial-ventricular node radiofrequency ablation at the same procedure, and the another one patient received CRTD. One out of seven patients died of re-AMI 4 months after the combination therapy, and the other 6 patients had been alive 5 - 41 (23.2 +/- 13.8) months during the follow-up period. The heart function of the 7 patients had further improved after PCI and CRT combined therapy compared to that of PCI or CRT only. Their NYHA class decreased from IV to II, 6-minute walking distance increased steadily, and mitral regurgitation reduced and QRS duration shortened significantly. The LVEDD decreased and LVEF increased significantly in 2 patients without ventricular aneurysm, and slight improvement or no change were in the other 5 patients.

CONCLUSIONFor patients with refractory heart failure secondary to ICM, the combination of PCI and CRT could obviously improve their heart function, quality of life and prognosis, which also very safe in perforation.