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[Cardiac resynchronization therapy-always with ICD?]
1Klinik für Kardiologie und internistische Intensivmedizin, Städtische Kliniken, Bielefeld. CHRISTOPH.STELLBRINK@SK-BIELEFELD.DE
Insights
Sudden cardiac death is a major concern in heart failure. Implantable cardioverter-defibrillators (ICDs) are effective in preventing sudden cardiac death, especially when combined with cardiac resynchronization therapy.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Context:
- Sudden cardiac death (SCD) accounts for approximately 50% of mortality in heart failure patients.
- Implantable cardioverter-defibrillators (ICDs) have demonstrated superiority over antiarrhythmic drugs for SCD prevention in specific patient groups.
- The efficacy of prophylactic ICDs in unselected heart failure populations is under investigation.
Purpose:
- To evaluate the role of prophylactic implantable cardioverter-defibrillator (ICD) therapy in reducing mortality in unselected heart failure patients.
- To assess the added benefit of ICDs in patients undergoing cardiac resynchronization therapy (CRT).
- To discuss the influence of recent studies on system choice for CRT.
Summary:
- Studies show that ICDs are superior to antiarrhythmic drugs in preventing sudden cardiac death in heart failure patients with coronary artery disease and reduced left ventricular function.
- For heart failure patients with intraventricular conduction delay, who are candidates for CRT, prophylactic ICD implantation offers minimal additional risk and significant survival benefit.
- Recent research confirms the benefits of both conventional ICD therapy and biventricular pacing in heart failure management.
Impact:
- Prophylactic ICD implantation can significantly reduce mortality in selected heart failure patients.
- The combination of ICD and CRT may be optimal for patients with heart failure and conduction delays.
- Findings guide clinical decision-making regarding device selection for heart failure patients at risk of sudden cardiac death.
Abstract:
Sudden cardiac death is responsible for about 50% of all deaths in heart failure. In studies on primary and secondary prevention of sudden cardiac death, the implantable cardioverter defibrillator (ICD) has proven superior to antiarrhythmic drug therapy mainly in patients with coronary artery disease and reduced left ventricular function. Thus, in recent years the question arose whether prophylactic ICD treatment can reduce mortality as well in an unselected patient group with heart failure of any etiology. This is even more important for patients that are candidates for cardiac resynchronization therapy because, first, presence of an intraventricular conduction delay indicates an increased risk of sudden death and, second, the additional operative morbidity of ICD implantation is minimal compared to implant of a biventricular pacemaker. Recent studies have proven the benefit of conventional ICD treatment in patients with heart failure as well as the benefit of biventricular pacing in heart failure patients with ventricular conduction delay. In the present article, these studies and their influence on the system choice in cardiac resynchronization therapy are discussed.
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