Electrical manipulation of the failing heart

Area of Science:

• Cardiology
• Medical Devices
• Heart Failure Management

Background:

• Chronic heart failure with reduced ejection fraction (HFrEF) carries significant mortality risk despite optimal medical therapy.
• Cardiac implantable electronic devices (CIED) have emerged as crucial tools for managing HFrEF, improving survival and functional capacity.
• Implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy (CRT) have evolved, with ongoing research in various HFrEF settings.

Purpose of the Study:

• To provide a comprehensive and pragmatic approach to electrical manipulation of the failing heart using ICD and CRT.
• To offer real-life-oriented advice for maximizing outcomes in CIED-based HFrEF therapy.
• To develop a framework for decision-making in patients considered for ICD and/or CRT.

Main Methods:

• Review of current evidence on ICD and CRT in HFrEF.
• Analysis of patient selection criteria for CIED implantation.
• Evaluation of technological advances in CIED implantation techniques and long-term management.

Main Results:

• CIEDs, specifically ICD and CRT, have demonstrated benefits in survival and functional capacity for HFrEF patients.
• Technological advancements have refined CIED therapy, though some applications remain debated.
• A structured approach to patient selection and management is crucial for optimizing CIED efficacy.

Conclusions:

• Optimizing CIED therapy requires careful patient selection, advanced implantation techniques, and diligent long-term follow-up.
• This review provides evidence-based guidance to enhance decision-making for ICD and/or CRT in HFrEF.
• A critical appraisal of recent evidence supports a refined approach to CIED therapy beyond traditional views.