Device Therapy for Heart Failure Patients

This chapter focuses on the state of knowledge in the evidence-based management of heart failure (HF) using device therapy. In particular, it summarizes the indications for, and the management of, implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) in HF. ICDs are small sophisticated devices implanted under the chest wall with leads into the myocardium through the venous system to detect and terminate arrhythmias with electroshock and/or pacing. The benefits, adverse outcomes, management and discontinuation of ICDs in HF patients are shown. CRT is obtained with a pacemaker-sized device that is implanted with three leads into: the atrium, the right ventricle, and via the coronary sinus into a vein on the lateral free wall of the left ventricle. The management of resynchronization devices is illustrated. In addition, decisionmaking with patients about CRT is covered. Both ICD and CRT should be implanted after careful review with the patient of device actions, potential benefits, and burdens.