What are invasive interventions?
Patients with CHF are at risk of sudden cardiac death (SCD) from arrhythmias such as ventricular tachycardia (VT) or ventricular fibrillation (VF) and heart failure may be worsened by cardiac dyssynchrony. Devices may only pace or have both pacing and defibrillator functions:
Implantable cardioverter defibrillator (ICD)
Cardiac resynchronization therapy (CRT)
Describe the ICD.
consist of a pulse generator and leads that can sense VF or VT and deliver a shock to restore sinus rhythm.
Patients with CHF are at risk of sudden cardiac death (SCD) from arrhythmias such as ventricular tachycardia (VT) or ventricular fibrillation (VF).
List indications for ICD implantation.
HFrEF with expected survival of > 1 year if, despite receiving optimized medical therapy for 3–6 months, the following criteria are still met:
Stage B with ischemic cardiomyopathy if LVEF is ≤ 30%
Stage C with dilated cardiomyopathy (DCM) or ischemic heart disease with an LVEF ≤ 35% and NYHA class II–III symptoms
Patients who have previously had sustained VT or a cardiac arrest secondary to VF or VT
Describe the CRT.
leads in the RA, RV, and coronary sinus (which lies adjacent to the LV) pace the heart in a coordinated manner.
What are benefits of CRT?
Improved ventricular function
Reversal of ventricular remodeling
Reduction of secondary mitral regurgitation
What are indications for CRT?
The criteria below apply to patients with stage C HFrEF with an LVEF ≤ 35% on optimized medical therapy and an expected survival of > 1 year.
NYHA class I–IV symptoms in sinus rhythm with QRS duration of > 150 ms (can be either left bundle branch block (LBBB) pattern or non-LBBB pattern)
Patients with LVEF ≤ 35% who require pacing for other purposes, e.g., atrial fibrillation, replacement of existing pacemaker
List general principles of end-stage HF.
Cardiac transplant is the only cure for end-stage heart failure; however, the majority of patients are not candidates.
Refer patients who are not candidates for transplant to palliative care.
Patients referred for transplant typically require bridging measures, including inotropic and mechanical circulatory support.
Describe the inotropic support for end-stage HF.
Used as a temporary measure to maintain organ perfusion in patients with cardiogenic shock
In rare cases, may be used for symptom control in patients receiving palliative care
Describe the mechanical circulatory support (MCS) for end-stage HF.
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