Device therapies in heart failure

1) Cardiac resynchronization therapy(biventricular pacing)-

Right and left ventricles are paced in a synchronous fashion to
improve ventricular contraction,mitral regurgitation and reverse re-
modelling.

Indications:1)NYHA class III and IV

2)Ejection fraction less or equal to 35%
3)wide QRS complex(equal or more than 0.12s)
 2) Implantable cardioverter defibrillator-
improve survival and prevent sudden death

Indications:
secondary prevention following cardiac arrest,ventricular
fibrillation or tachycardia
Primary prevention for severe symptomatic heart failure
despite optimal medical therapy
 Surgeries in heart failure
A) Revascularization Procedures
Patients with CAD and HF may benefit from revascularization
by either PCI or coronary artery bypass surgery (CABG),
particularly if they have angina and anatomy that is suitable for
revascularization (left main stem or triple vessel disease).
The benefit of revascularization is likely to be more in patients
with mild left ventricular dysfunction, severe CAD with angina,
viable myocardium and reversible ischemia
 B)Valve surgery
Patients with HF and severe mitral regurgitation, non
ischemic in origin, may have symptomatic improvement
after mitral valve surgery.
If the LVEF <30%, mitral valve repair is preferred as mitral
valve replacement is associated with poorer outcomes

C)LV Reduction Surgery
LV aneurysmectomy is indicated in patients with a large
discrete LV aneurysm who develop HF, angina pectoris,
thromboembolism, and tachyarrhythmias due to the
aneurysm]

D)Left ventricular assisted devices

These temprorarily provide mechanical support till cardiac
transplant is performed
 Cardiac transplantation
Considered for otherwise healthy patients with severe refractory
cardiac failure who fail to respond to medical therapy.
Median life expectancy after transplant is 10 years.
Indicators of severe HF and consideration for heart transplantation
include:
Poor LVEF (<25%)
Recurrent admissions or major limitation of the patients daily
activities
Poor effort tolerance i.e. peak VO2 less than 10 ml per kg per min
iv inotropic dependence