Current evidence-based guidelines recommend an implantable cardioverter-defibrillator for the primary prevention of sudden cardiac death in selected patients with impaired left ventricular function, and cardiac resynchronization therapy for improvement of symptoms and survival in selected patients with impaired left ventricular function and abnormal ventricular conduction. Many patients may be eligible for both treatments, but it does not necessarily follow that such patients would obtain additional benefit from the combined treatment over one treatment alone. A simple pragmatic approach would be to use resynchronisation therapy, in order to reduce symptoms and extend life in patients with New York Heart Association class III or IV heart failure, with the addition of an implantable cardioverter-defibrillator left to clinical judgment on an individual basis when additional indications exist. When such an addition is contemplated the hypothesized incremental benefits in survival would need to be balanced by the possible increase in morbidity owing to, for example, inappropriate shocks.