Cardiac resynchronization therapy (CRT) was shown to improve cardiac function, reduce heart failure hospitalizations, improve quality of life and prolong survival in patients with severe left ventricular dysfunction and intraventricular conduction disturbances, mainly left bundle branch block, on optimal medical therapy with ACE-inhibitors, β-blockers and mineralocorticoid receptor antagonists up-titrated to maximum tolerated evidence-based doses. CRT can be achieved by means of pacemaker systems (CRT-P) or devices with defibrillation capabilities (CRT-D). CRT-Ds offer an undoubted advantage in the prevention of arrhythmic death, but such an advantage may be of lesser degree in nonischemic heart failure etiologies. Moreover, the higher CRT-D hardware complexity compared to CRT-P may predispose to device/lead malfunctions and the higher current drainage may cause a shorter battery duration with consequent premature replacements and the well-known incremental complications. In a period of financial constraints, also device costs should be carefully evaluated, with recent reports suggesting that CRT-Ps may be favored over CRT-Ds in patients with nonischemic cardiomyopathy and no prior history of cardiac arrhythmias from a cost-effectiveness point of view. The choice between a CRT-P or a CRT-D device should be patient-tailored whenever straightforward defibrillator indications are not present. The Goldenberg score may facilitate this decision-making process in ambiguous settings. Age, comorbidities, kidney disease, atrial fibrillation, advanced functional class, inappropriate therapy risk, implantable device infections, and malfunctions are factors potentially reducing the expected benefit from defibrillating capabilities. In the future, prospective randomized controlled trials are warranted to directly compare the efficacy and safety of CRT-Ps and CRT-Ds.

心脏再同步化治疗 (CRT) 被证明可以改善心脏功能，减少心力衰竭住院，改善生活质量，延长严重左心室功能障碍和心室内传导障碍（主要是左束支传导阻滞）患者的生存期抑制剂、β-受体阻滞剂和盐皮质激素受体拮抗剂上调至最大耐受循证剂量。CRT 可以通过起搏器系统 (CRT-P) 或具有除颤功能的设备 (CRT-D) 来实现。CRT-D 在预防心律失常性死亡方面具有无可置疑的优势，但在非缺血性心力衰竭病因中这种优势可能较小。而且，与 CRT-P 相比，CRT-D 硬件复杂性较高可能会导致设备/引线故障，而较高的电流消耗可能会导致电池持续时间较短，从而导致过早更换和众所周知的增量并发症。在财政拮据的时期，还应仔细评估设备成本，最近的报告表明，从成本效益的角度来看，对于非缺血性心肌病且既往无心律失常病史的患者，CRT-P 可能优于 CRT-D . 当没有直接的除颤器指示时，应根据患者选择 CRT-P 或 CRT-D 设备。Goldenberg 评分可能会在模棱两可的环境中促进这一决策过程。年龄、合并症、肾脏疾病、心房颤动、高级功能分级、不适当的治疗风险、植入设备感染和故障是可能降低除颤功能预期收益的因素。未来，有必要进行前瞻性随机对照试验，直接比较 CRT-P 和 CRT-D 的疗效和安全性。