Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy in the Treatment of Heart Failure with Reduced Ejection Fraction

Ilaria Spoletini, Andrew Coats

Abstract


It has been long acknowledged that electrical-conduction disturbances may be both a cause of heart failure and a consequence of it. In fact, many patients with heart failure have an asynchronous contraction pattern of the heart muscle that further reduces the heart ability to pump blood. Electrical disturbances may therefore result in progressive left ventricular dysfunction, due to the added effects of HF-related electrical dyssynchrony. For this reason, device therapy may play a key role in the management of patients with heart failure and reduced ejection fraction (HFrEF). In particular, Implantable Cardioverter- Defibrillators (ICD) and Cardiac Resynchronization Therapy (CRT) may improve ejection fraction by reestablishing mechanical synchrony, possibly reversing symptoms and signs of heart failure, in addition to the more obvious role of ICD in terminating ventricular arrhythmias that threaten sudden death. Recommendations on device therapy from the current guidelines on heart failure management put out by the ESC/HFA in 2016 update our understanding of the evidence base for the use of ICD and CRT in HFrEF. We review these recommendations and the evidence behind them.

Keywords


Cardiology; Devices; Guidelines

Full Text:

445

References


Ukkonen, H., R. S. Beanlands, I. G. Burwash, R. A. de Kemp, C. Nahmias, E. Fallen, M. R. Hill and A. S. Tang (2003). Effect of cardiac resynchronization on myocardial efficiency and regional oxidative metabolism. Circulation 107(1): 28–31.

Biton, Y., J. R. Baman and B. Polonsky (2016). Roles and indications for use of implantable defibrillator and resynchronization therapy in the prevention of sudden cardiac death in heart failure. Heart Fail Rev. 2016 Jul;21(4):433-46. doi: 10.1007/s10741-016-9542-y.

Shea, J. B. and M. O. Sweeney (2003). Cardiology patient page. Cardiac resynchronization therapy: a patient’s guide. Circulation 108(9): e64–66.

Kadish, A., A. Dyer, J. P. Daubert, R. Quigg, N. A. Estes, K. P. Anderson, H. Calkins, D. Hoch, J. Goldberger, A. Shalaby, W. E. Sanders, A. Schaechter, J. H. Levine and I. Defibrillators in Non- Ischemic Cardiomyopathy Treatment Evaluation (2004). Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med 350(21): 2151–2158.

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González- Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; Authors/Task Force Members; Document Reviewers. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016 May 20. pii: ehw128. PMID: 27206819.

Mirowski, M. and M. M. Mower (1973). Transvenous automatic defibrillator as an approach to prevention of sudden death from ventricular fibrillation. Heart Lung 2(6): 867–869.

Kadish, A. and M. Mehra (2005). Heart failure devices: implantable cardioverter- defibrillators and biventricular pacing therapy. Circulation 111(24): 3327–3335.

Priori, S. G., C. Blomstrom- Lundqvist, A. Mazzanti, N. Blom, M. Borggrefe, J. Camm, P. M. Elliott, D. Fitzsimons, R. Hatala, G. Hindricks, P. Kirchhof, K. Kjeldsen, K. H. Kuck, A. Hernandez- Madrid, N. Nikolaou, T. M. Norekval, C. Spaulding and D. J. Van Veldhuisen (2015). 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 36(41): 2793–2867.

Hohnloser, S. H., K. H. Kuck, P. Dorian, R. S. Roberts, J. R. Hampton, R. Hatala, E. Fain, M. Gent, S. J. Connolly and D. Investigators (2004). Prophylactic use of an implantable cardioverter- defibrillator after acute myocardial infarction. N Engl J Med 351(24): 2481–2488.

Steinbeck, G., D. Andresen, K. Seidl, J. Brachmann, E. Hoffmann, D. Wojciechowski, Z. Kornacewicz- Jach, B. Sredniawa, G. Lupkovics, F. Hofgartner, A. Lubinski, M. Rosenqvist, A. Habets, K. Wegscheider, J. Senges and I. Investigators (2009). Defibrillator implantation early after myocardial infarction. N Engl J Med 361(15): 1427–1436.

Moss, A. J., W. Zareba, W. J. Hall, H. Klein, D. J. Wilber, D. S. Cannom, J. P. Daubert, S. L. Higgins, M. W. Brown, M. L. Andrews and I. I. I. Multicenter Automatic Defibrillator Implantation Trial (2002). Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346(12): 877–883.

Desai, A. S., J. C. Fang, W. H. Maisel and K. L. Baughman (2004). Implantable defibrillators for the prevention of mortality in patients with nonischemic cardiomyopathy: a meta- analysis of randomized controlled trials. JAMA 292(23): 2874–2879.

Cook, N. R. and P. M. Ridker (2009). Advances in measuring the effect of individual predictors of cardiovascular risk: the role of reclassification measures. Ann Intern Med 150(11): 795–802.

Theuns, D. A., T. Smith, M. G. Hunink, G. H. Bardy and L. Jordaens (2010). Effectiveness of prophylactic implantation of cardioverter- defibrillators without cardiac resynchronization therapy in patients with ischaemic or non- ischaemic heart disease: a systematic review and meta- analysis. Europace 12(11): 1564–1570.

Bardy, G. H., K. L. Lee, D. B. Mark, J. E. Poole, D. L. Packer, R. Boineau, M. Domanski, C. Troutman, J. Anderson, G. Johnson, S. E. McNulty, N. Clapp- Channing, L. D. Davidson- Ray, E. S. Fraulo, D. P. Fishbein, R. M. Luceri, J. H. Ip and I. Sudden Cardiac Death in Heart Failure Trial (2005). Amiodarone or an implantable cardioverter- defibrillator for congestive heart failure. N Engl J Med 352(3): 225–237.

Sanders, G. D., M. A. Hlatky and D. K. Owens (2005). Cost- effectiveness of implantable cardioverter- defibrillators. N Engl J Med 353(14): 1471–1480.

Miller, R. J., J. G. Howlett, D. V. Exner, P. M. Campbell, A. D. Grant and S. B. Wilton (2015). Baseline Functional Class and Therapeutic Efficacy of Common Heart Failure Interventions: A Systematic Review and Meta- analysis. Can J Cardiol 31(6): 792–799.

Raphael, C. E., J. A. Finegold, A. J. Barron, Z. I. Whinnett, J. Mayet, C. Linde, J. G. Cleland, W. C. Levy and D. P. Francis (2015). The effect of duration of follow- up and presence of competing risk on lifespan- gain from implantable cardioverter defibrillator therapy: who benefits the most? Eur Heart J 36(26): 1676–1688.

Connolly, S. J., M. Gent, R. S. Roberts, P. Dorian, D. Roy, R. S. Sheldon, L. B. Mitchell, M. S. Green, G. J. Klein and B. O’Brien (2000). Canadian implantable defibrillator study (CIDS) : a randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation 101(11): 1297–1302.

Connolly, S. J., A. P. Hallstrom, R. Cappato, E. B. Schron, K. H. Kuck, D. P. Zipes, H. L. Greene, S. Boczor, M. Domanski, D. Follmann, M. Gent and R. S. Roberts (2000). Meta- analysis of the implantable cardioverter defibrillator secondary prevention trials. AVID, CASH and CIDS studies. Antiarrhythmics vs Implantable Defibrillator study. Cardiac Arrest Study Hamburg. Canadian Implantable Defibrillator Study. Eur Heart J 21(24): 2071–2078.

Erkapic, D., J. Sperzel, S. Stiller, U. Meltendorf, J. Mermi, K. Wegscheider, B. Hugl and I. Investigators (2013). Long- term benefit of implantable cardioverter/defibrillator therapy after elective device replacement: results of the INcidence free SUrvival after ICD REplacement (INSURE) trial – a prospective multicentre study. Eur Heart J 34(2): 130–137.

Kini, V., M. K. Soufi, R. Deo, A. E. Epstein, R. Bala, M. Riley, P. W. Groeneveld, A. Shalaby and S. Dixit (2014). Appropriateness of primary prevention implantable cardioverter- defibrillators at the time of generator replacement: are indications still met? J Am Coll Cardiol 63(22): 2388–2394.

Yap, S. C., B. A. Schaer, R. E. Bhagwandien, M. Kuhne, L. Dabiri Abkenari, S. Osswald, T. Szili- Torok, C. Sticherling and D. A. Theuns (2014). Evaluation of the need of elective implantable cardioverter- defibrillator generator replacement in primary prevention patients without prior appropriate ICD therapy. Heart 100(15): 1188–1192.

Opreanu, M., C. Wan, V. Singh, N. Salehi, J. Ahmad, S. J. Szymkiewicz and R. K. Thakur (2015). Wearable cardioverter- defibrillator as a bridge to cardiac transplantation: A national database analysis. J Heart Lung Transplant 34(10): 1305–1309.

Kumar, P. and J. D. Schwartz (2015). Device therapies: new indications and future directions. Curr Cardiol Rev 11(1): 33–41.

Sohaib, S. M., J. A. Finegold, S. S. Nijjer, R. Hossain, C. Linde, W. C. Levy, R. Sutton, P. Kanagaratnam, D. P. Francis and Z. I. Whinnett (2015). Opportunity to increase life span in narrow QRS cardiac resynchronization therapy recipients by deactivating ventricular pacing: evidence from randomized controlled trials. JACC Heart Fail 3(4): 327–336.

Linde, C., M. Stahlberg, L. Benson, F. Braunschweig, M. Edner, U. Dahlstrom, U. Alehagen and L. H. Lund (2015). Gender, underutilization of cardiac resynchronization therapy, and prognostic impact of QRS prolongation and left bundle branch block in heart failure. Europace 17(3): 424–431.

Woods, B., N. Hawkins, S. Mealing, A. Sutton, W. T. Abraham, J. F. Beshai, H. Klein, M. Sculpher, C. J. Plummer and M. R. Cowie (2015). Individual patient data network meta- analysis of mortality effects of implantable cardiac devices. Heart 101(22): 1800–1806.

Cleland, J. G., W. T. Abraham, C. Linde, M. R. Gold, J. B. Young, J. Claude Daubert, L. Sherfesee, G. A. Wells and A. S. Tang (2013). An individual patient meta- analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. Eur Heart J 34(46): 3547–3556.

Cleland, J. G., Y. Mareev and C. Linde (2015). Reflections on EchoCRT: sound guidance on QRS duration and morphology for CRT? Eur Heart J 36(30): 1948–1951.

Stewart, G. C., J. R. Weintraub, P. P. Pratibhu, M. J. Semigran, J. M. Camuso, K. Brooks, S. W. Tsang, M. S. Anello, V. T. Nguyen, E. F. Lewis, A. Nohria, A. S. Desai, M. M. Givertz and L. W. Stevenson (2010). Patient expectations from implantable defibrillators to prevent death in heart failure. J Card Fail 16(2): 106–113.

Ruschitzka, F., W. T. Abraham, J. P. Singh, J. J. Bax, J. S. Borer, J. Brugada, K. Dickstein, I. Ford, J. Gorcsan, 3rd, D. Gras, H. Krum, P. Sogaard, J. Holzmeister and C. R. T. S. G. Echo (2013). Cardiac- resynchronization therapy in heart failure with a narrow QRS complex. N Engl J Med 369(15): 1395–1405.

Steffel, J., M. Robertson, J. P. Singh, W. T. Abraham, J. J. Bax, J. S. Borer, K. Dickstein, I. Ford, J. Gorcsan, 3rd, D. Gras, H. Krum, P. Sogaard, J. Holzmeister, J. Brugada and F. Ruschitzka (2015). The effect of QRS duration on cardiac resynchronization therapy in patients with a narrow QRS complex: a subgroup analysis of the EchoCRT trial. Eur Heart J 36(30): 1983–1989.

Shewan L.G., Coats A.J.S., Henein M. Requirements for Ethical Publishing in Biomedical Journals. International Cardiovascular Forum Journal. 2015;2:2. http://dx.doi.org/10.17987/icfj.v2i1.4




DOI: https://doi.org/10.17987/icfj.v10i0.445


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