Device therapy in heart failure with reduced ejection fraction-cardiac resynchronization therapy and more

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Devices

Background:

• Heart failure with reduced ejection fraction (HFrEF) management includes optimal medical therapy and established device therapies.
• Cardiac resynchronization therapy (CRT) is indicated for symptomatic HFrEF patients with a broad QRS complex and left bundle branch block (LBBB) morphology.
• Many HFrEF patients lack CRT candidacy due to narrow QRS complexes or non-LBBB morphology.

Purpose of the Study:

• To provide an overview of device-based therapeutic options for HFrEF patients.
• To highlight alternative electrical therapies for HFrEF patients not eligible for CRT.
• To discuss the roles of Baroreflex Activation Therapy (BAT) and Cardiac Contractility Modulation (CCM) in HFrEF management.

Main Methods:

• Review of established and emerging device-based therapies for HFrEF.
• Analysis of indications and mechanisms for CRT, BAT, and CCM.
• Discussion of current data limitations, particularly regarding mortality for BAT and CCM.

Main Results:

• Optimal medical therapy and established devices (ICDs, CRT) are cornerstones of HFrEF treatment.
• CRT is a class I indication for specific HFrEF patient subgroups.
• Baroreflex Activation Therapy (BAT) and Cardiac Contractility Modulation (CCM) offer potential alternatives for non-CRT candidates, though mortality data are pending.

Conclusions:

• Device-based therapies play a crucial role in managing HFrEF.
• Alternative therapies like BAT and CCM are emerging options for select HFrEF patients.
• Further research is needed to establish long-term outcomes, including mortality, for BAT and CCM.