[Commentary on the 2010 ESC guidelines on device therapy in heart failure ]

Area of Science:

• Cardiology
• Medical Device Therapy
• Heart Failure Management

Context:

• The 2010 focused update of European Society of Cardiology (ESC) guidelines addresses device therapy for heart failure.
• Previous guidelines are specified, and new findings are incorporated, particularly for NYHA class II patients.

Purpose:

• To present the renewed guidelines on pacemakers and cardiac resynchronization therapy (CRT) for heart failure treatment.
• To outline expanded indications for device therapy based on recent study findings.

Summary:

• Cardiac resynchronization therapy (CRT) is now indicated for NYHA class III and IV heart failure patients regardless of left ventricular dilatation.
• CRT indications are expanded to include NYHA class II patients with specific left bundle branch block and QRS duration criteria.
• Device therapy, including left ventricular assist devices for end-stage heart failure, is broadened.
• CRT is recommended for heart failure patients with permanent atrial fibrillation and specific QRS durations.
• In patients requiring pacemakers for AV block, CRT is generally indicated to prevent heart failure progression.

Impact:

• Expanded indications for CRT and device therapy in heart failure management.
• Improved treatment strategies for heart failure patients, especially those in NYHA class II.
• Highlights areas requiring further investigation in randomized trials, such as CRT in permanent atrial fibrillation and heart block.