Devices in Heart Failure Patients-Who Benefits From ICD and CRT?

Alexander Breitenstein,Jan Steffel

doi:10.3389/fcvm.2019.00111

Abstract

Despite advances in heart failure treatment, this condition remains a relevant medical issue and is associated with a high morbidity and mortality. The cause of death in patients suffering from heart failure is not only a result of hemodynamic failure, but can also be due to ventricular arrhythmias. Implantable cardioverter defibrillators (ICDs) are these days the only tool to significantly reduce arrhythmic sudden death; but not all patients benefit to the same extend. In addition, cardiac resynchronization therapy (CRT) is another tool which is used in patients suffering from heart fialure. Even though both devices have been investigated in large randomized trials, both ICD and CRT remain underutilized in many countries. This brief review focuses on various aspects in this regard including a short overview on upcoming device novelties in the near future.

Highlights

According to current ESC guidelines, heart failure can be separated into heart failure with preserved ejection fraction (LVEF > 50%; HFpEF), mid-range EF (LVEF 40–49%; HFmrEF) and reduced ejection fraction (LVEF < 40%; HFrHF) [1]
Even though current guidelines recommend the implantation of an Implantable cardioverter defibrillators (ICDs) in patients suffering from heart failure with an LVEF ≤ 35% despite at least 3 months of optimal medical treatment, a NYHA class II-IVa and a predicted survival of > 1 year, there seems to be a discrepancy of the beneficial effect of an ICD depending on the underlying heart disease
Two large trials investigated the role of an ICD in the primary prevention context: The Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) [4] and the Multicenter Automatic Defibrillator Implantation

Summary

INTRODUCTION

According to current ESC guidelines, heart failure can be separated into heart failure with preserved ejection fraction (LVEF > 50%; HFpEF), mid-range EF (LVEF 40–49%; HFmrEF) and reduced ejection fraction (LVEF < 40%; HFrHF) [1]. Cardiac resynchronization therapy (CRT) is an established treatment option significantly improving both quality of life as well as mortality. In spite of these proven benefits, both ICD as well as CRT therapy remain underutilized in many countries [2]. This brief review focusses on some of the most important aspects in this regard, including continuing medical education regarding the pathophysiology, epidemiology, clinical trial results as well as novel technologies, which are paramount to allow for optimal dissemination of these important therapies and to reduce morbidity and mortality in this fragile patient population

Devices in Heart Failure

Indication CRT

Findings

CONCLUSION