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Device Therapy for Patients with Heart Failure

Device Therapy for Patients with Heart Failure

Implantable cardiac defibrillator

An implantable cardiac defibrillator (ICD) is an electronic device that constantly monitors the patient’s heart rhythm. When the device detects certain abnormal heart rhythms, it delivers a small shock to the heart muscle to restore a normal heart rhythm. The shock will be brief and may feel very uncomfortable. Studies show that an ICD can reduce the risk of sudden cardiac arrest (SCA).

Heartmate II implanted

Sudden cardiac arrest

Sudden cardiac arrest (SCA, sometimes called sudden cardiac death [SCD]) is a sudden, unexpected death caused by a loss of heart function due to an abnormal heart rhythm (arrhythmia). The ventricles (lower chambers of the heart) flutter or quiver (ventricular fibrillation) or the heart beats dangerously fast (ventricular tachycardia), and blood is not delivered to the rest of the body. A person suffering SCA will first lose consciousness, and death will follow. SCA is responsible for 30 percent of deaths among patients with mild to moderate heart failure.

Patients with heart failure are 6 to 9 times more likely than the general population to experience ventricular arrhythmias that can lead to SCA. Because you are at risk for SCA, talk to your family members so they understand your condition and the importance of seeking immediate care in the event of an emergency. Family members and friends of those at risk for SCA should know how to perform cardiopulmonary resuscitation (CPR).

Although more than 90 percent of people who suffer SCA die, it can be treated and reversed if the person receives immediate emergency action. Survival is as high as 90 percent if treatment is initiated within the first minutes after arrhythmia begins, but the survival rate decreases by about 10 percent each minute the patient waits for treatment.

Prevention of SCA and death includes placement of an implantable cardioverter defibrillator (ICD).

Emergency treatment for SCA includes CPR and defibrillation.

Cardiac resynchronization therapy

Some patients with systolic heart failure can benefit from cardiac resynchronization therapy (CRT), also referred to as biventricular pacing, which helps the heart’s lower chambers (ventricles) contract normally.

About 30% of patients with heart failure have electrical problems in one or more ventricles that cause delays in ventricular muscle contraction (pumping). When the ventricular muscles do not contract together, the amount of oxygen-rich blood the heart normally pumps to the body’s organs and muscles is decreased. Pumping delays make heart failure worse (increased fatigue, shortness of breath and other symptoms) and can increase the risk of sudden cardiac arrest (SCA) and death from heart failure.

CRT involves the implantation of a pacemaker with 3 leads (wires) that keeps the left and right ventricles pumping together. The pacemaker sends small, painless electrical impulses to the heart muscle through the leads that cause the right and left ventricles to be stimulated at the same time.

Some patients with heart failure may benefit from combination therapy with CRT and an ICD. The use of a combination device (CRT-D) keeps the left and right ventricles of the heart beating together and can shock the heart back into normal rhythm if ventricular tachycardia or ventricular fibrillation occurs.

CRT, with or without an ICD, improves symptoms in about half of all patients with heart failure who still have symptoms after exhausting all medication options. CRT improves survival, quality of life, heart function, the ability to exercise, and helps decrease hospitalizations in some patients with systolic heart failure.

Internal monitoring devices

Many internal cardiac devices have monitoring features and software so your doctor or nurse can monitor not only your heart rhythm, but also your heart function and activity level. You may be asked to use a telephone to send information from your device to a computer server so your condition can be monitored. Or, your device may use a handheld personal digital assistant (PDA) to send data to your healthcare provider. Other types of internal monitoring devices are emerging. For example, one device that is the size of a small paper clip can be placed in a blood vessel near your heart to monitor pressure in the blood vessel and left ventricle. The information can be sent to a computer server so your doctor or nurse can remotely review your heart function and give you treatment advice. These and other devices may let your healthcare team watch trends in your heart function that could lead to changes in the medications you take and reinforce the importance of a healthy diet, exercise, medication and monitoring to stay healthy.

Sources

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 12/10/2010…#12906