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Selecting appropriate cardiac device for patients with Heart Failure

Pacemakers, Implanted cardioverter defibrillators (ICD), Cardiac Resynchronization Treatment (CRT) devices, and Left Ventricular Assist Devices (LVAD) are examples of few devices used to manage heart failure patients and help by regulating heart rhythm issues and/or improving heart function.

Selecting appropriate cardiac device for patients with Heart Failure
Newer pacemakers are now available that are leadless and are miniature devices that are implanted directly in the heart and eliminate the need for transvenous leads. (File)

By Dr. Kartikeya Bhargava

Cardiac healthcare has observed a paradigm shift in the past decades owing to the advent of newer technology. Artificial Intelligence (AI), Machine Learning (ML), and imaging technology have supported cardiologists to tackle the most complicated cases with ease and deliver quality treatment. With technology in the picture, heart disease does not necessarily mean the inevitable. Implantable Cardiac devices can not only keep your heart in normal rhythm but also help in improving the heart function or efficiency. If you or someone you know has heart failure with reduced ejection fraction (HFrEF), the treating doctor will assess and advise the best type of cardiac device suitable. Many different devices are implanted in patients suffering from heart failure. 

Pacemakers, Implanted cardioverter defibrillators (ICD), Cardiac Resynchronization Treatment (CRT) devices, and Left Ventricular Assist Devices (LVAD) are examples of few devices used to manage heart failure patients and help by regulating heart rhythm issues and/or improving heart function.

Pacemakers are devices used to treat slow heart rhythm or bradycardia. The conventional pacemakers are implanted beneath the skin and are attached to leads that reach the chambers of heart. Newer pacemakers are now available that are leadless and are miniature devices that are implanted directly in the heart and eliminate the need for transvenous leads. The pacemaker sends electrical impulses to the heart and prevent it from becoming inappropriately slow.

An implantable cardiac-defibrillator (ICD) is an implantable medical device that continually monitors your heart rhythm, promptly recognizes abnormally fast, potentially life-threatening heart rhythms and automatically treats them by delivering a small electric shock to the heart muscle. A shock can be painful if you haven’t lost consciousness due to the rapid rhythm disturbance but will save your life prevent sudden death. Many of these abnormal rhythms are treated first by painless pacing pulses given by the ICD device and shock is needed only if these don’t work. An ICD device can significantly reduce the risk of sudden cardiac death (SCD) in patients at high risk of sudden cardiac arrest (SCA).

Cardiac Resynchronization Therapy (CRT) devices improve overall efficiency of the heart by synchronizing the contraction pattern of different chambers of the heart. Some selected individuals with HFrEF that have specific electrical abnormality may benefit from this therapy, also termed as biventricular pacing. The erratic pumping due to dyssynchronous contraction pattern due to the electrical abnormality is rectified by CRT devices and with resultant improvement in pumping efficiency and reduction in wasteful contraction. CRT device is like a pacemaker that is implanted in a procedure performed under local anesthesia wherein three electrical leads are implanted in different heart chambers and connected to the device placed beneath the skin. These devices not only improve signs and symptoms of heart failure but also improve survival in these patients.

Left Ventricular Assist Device (LVADs): People with end-stage heart failure used to have to hope for a transplant. Advanced comorbid conditions and age-related factors may make the patient ineligible for a transplant. Moreover, the availability of heart for transplantation has always been an issue. LVADs were originally conceived as “bridge” therapy to enable individuals with a weak left ventricle (the main pumping chamber of the heart) to live while waiting for a heart transplant. LVADs are pump-like devices that are surgically implanted and “assist” the weakened heart in circulating blood throughout the body. In patients with advanced HFrEF, LVAD is nowadays also used as a standalone therapy option in those who cannot get or are not candidates for heart transplant.

(The author is Senior Director, Cardiac Electrophysiology and Pacing, Heart Institute, Medanta-The Medicity, Gurugram. Views expressed are personal and do not reflect the official position or policy of the FinancialExpress.com.)

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First published on: 09-10-2022 at 12:00:00 pm