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Device based treatment of heart failure

The Cardiothoracic Centre, Liverpool, UK

Correspondence to:
Correspondence to:
Dr A Patwala
The Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK; a_patwala{at}lineone.net

As the population ages and survival from ischaemic heart disease improves, the incidence and prevalence of congestive cardiac failure has increased dramatically. Medical treatments including ACE inhibitors, ß blockers, and aldosterone antagonists have improved the outlook for most patients. However, despite optimal medical treatment there is a significant group of patients who continue to suffer poor morbidity and mortality. Device based treatment consisting of implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT) devices offer new modes of treatment to patients with symptomatic heart failure despite optimal medical therapy. ICDs have been shown to reduce mortality in patients with severe heart failure while CRT leads to an improvement in functional class, quality of life scores, physiological measures such as peak VO₂, and reduce hospitalisations. Combination devices, which provide both ICD and CRT functions, have now been seen to provide synergistic benefits in selected patients.

Abbreviations: ICD, implantable cardioverter defibrillator; CRT, cardiac resynchronisation therapy; ACE, angiotensin converting enzyme; ARB, angiotensin receptor blocker; MI, myocardial infarction; EPS, electrophysiological study; RV, right ventricular; LV, left ventricular; BiV, biventricular; EF, ejection fraction

Keywords: bieventricular pacing; cardiac resynchronisation therapy; heart failure; implantable cardioverter defibrillator