CRT-D or CRT-P in CRT-indicated patients?

Cardiac resynchronization therapy with defibrillator (CRTD) has demonstrated advantages over implantable cardioverter defibrillator (ICD) in terms of morbidity, symptom reduction, and survival. But there is no exact data indicating benefit of adding an ICD in CRT-indicated patients, despite theoretically decreased risk of death due to arrhythmia with this combination (1). Despite the lack of evidence, CRT-D is preferred over cardiac resynchronization therapy with pacemaker (CRT-P) without any strict recommendation. Here we would like to share our experience, which also favors CRT-D over CRT-P, but for another reason: pacing site-dependent arrhythmia.