Journal Mobile

JG Cleland, L Buga, J Ghosh, M Nasir
Journal Issue: 
Volume 40: Issue 3: 2010




In terms of engineering, clinical understanding and application, device therapy  remains  in  its  infancy.  In  clinical  trials,  implantable  cardiac  defibrillators (ICDs) have greatly reduced the rate of sudden death and had a modest impact on mortality in a relatively broad range of patients. They do not generally improve symptoms and may make them worse. Cardiac resynchronisation therapy (CRT) devices have been used more selectively – probably far too selectively – and have shown substantial improvement in symptoms and a large reduction in mortality both by reducing sudden death and death due to heart failure. These effects are not explained solely by improved ventricular function, and the clinical response to therapy has so far not been predicted well by any method of assessing cardiac function or dyssynchrony. Reduction in brady-arrhythmia-triggered sudden death may be an underestimated benefit of biventricular pacing. In recent trials, heart failure  patients  implanted  with  a  device  have  had  a  remarkably  low  mortality. This  forces  the  clinical  community  to  contemplate  universal  device  use  for patients  with  heart  failure,  except  in  those  who  have  irremediable,  life-limiting, non-cardiac disease. For most patients this should be CRT or a combination of CRT and an ICD (CRT-D).