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Implantable Heart Device Therapies
With the rapid increase of patients experiencing heart failure and challenges in clinical practice to manage advanced heart failure syndromes, therapies with an implantable device have become an essential treatment method. Such therapies fall into two main categories according to the nature of HF: as a standard of care, patients afflicted with ventricular dyssynchrony, a disorder of the heart rhythm, are treated by cardiac resynchronization therapy (CRT), whereas hemodynamically compromised patients, i.e., whose heart has a reduced ability to adequately pump and/or fill with blood without ventricular dyssynchrony are not candidates to CRT, and are treated with MCS when indicated.
Cardiac resynchronization therapy uses an implantable biventricular pacemaker (CRT-P) to send electric signals to the heart’s left and right ventricles to synchronize contractions and improve cardiac output. CRTs are an admirable therapeutic option but are limited to patients whose HF is worsened by electrical dyssynchrony, typically from a left bundle branch block. The CRT system consists of an implantable pulse generator and insulated lead wires designed to deliver electrical charges to the heart, which help restore the normal timing pattern of the heartbeat.
Today, CRT devices combine pacing capability with implantable cardioverter-defibrillator (ICD). Implanted in the chest, an ICD is a small device that continually monitors the heart’s rhythm, detecting abnormal heartbeats. In the event it senses a dangerous erratic heart rhythm, or when arrhythmias lead to sudden cardiac arrest, it delivers an internal electric shock to the heart with the intent of restoring a normal heart rhythm (CRT-D).
Complementing the use of ICDs, techniques of severe heart rhythm disorders based on radio-frequency ablation provide renewed hope of comfort and survival.
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