Care-HF CArdiac Resynchronization in Heart Failure

Inclusion Criteria:

• Heart failure for at least 6 weeks requiring loop diuretics
• Currently in NYHA class III/IV
• A high standard of pharmacological therapy
• LV systolic dysfunction and dilation (EF <=35%; EDD >30mm/height in metres)
• QRS >=120 ms Dyssynchrony confirmed by echo if QRS 120-149 ms (Aortic pre-ejection delay >140ms, Interventricular mechanical delay >40 ms, Delayed activation of postero-lateral LV wall)

Exclusion Criteria:

• Age < 18 years old or age < legal age defined in the country in case different
• Chronic atrial fibrillation within 6 weeks prior to randomization;
• Impairment of left ventricular function not related to left ventricular systolic function
• Potentially reversible forms of cardiomyopathy:
• Cardiac surgery, percutaneous coronary intervention, cardiomyoplasty, myocardial infarction,unstable severe angina or stroke within 6 weeks before randomization
• A conventional indication for bradyarrhythmia pacing exists;
• A conventional indication for an ICD exists
• A pacemaker or ICD has already been implanted;
• In-Patients requiring continuous intravenous therapy for Heart Failure;
• Life expectancy < 1 year for disease unrelated to Heart Failure;
• Pregnancy or childbearing potential and not on reliable contraceptive;
• Mechanical tricuspid valve;
• Anticipated compliance problem or participation in another trial;