Devices for heart failure

Cardiac devices play an important role in the treatment of heart failure. Implantable cardioverter defibrillators (ICDs) prevent sudden cardiac death from ventricular arrhythmias and prolong life in specific subgroups of patients. This article explains how to identify appropriate primary and secondary prevention patients, based on left ventricular ejection fraction, heart failure aetiology and arrhythmia history. The cost, both financial and through morbidities such as inappropriate shock therapies, is examined. The mechanism by which ICDs detect arrhythmias and deliver shocks and anti-tachycardia pacing is explained. Cardiac resynchronization therapy (CRT) biventricular pacing can overcome the dyssynchrony resulting from left bundle branch block and subsequently improve cardiac output in the failing heart. Despite numerous imaging studies, left bundle branch block on the 12-lead ECG is still the best way to identify patients who may respond to CRT. The selection of appropriate patients, overcoming the challenges that stand in the way of successful left ventricular lead placement and the potential complications associated with CRT are presented in this article. Exciting new developments in cardiac devices, such as remote home monitoring, are addressed. After completing this article, readers should be familiar with the role of modern-day cardiac devices used in the management of ventricular tachyarrhythmias and heart failure.