Pacemakers for Heart Failure

Introduction

Heart failure (HF) is a chronic condition in which the heart cannot pump blood efficiently. In some cases, a special type of pacemaker, known as a cardiac resynchronization therapy (CRT) device, can help improve heart function.

What is a Pacemaker?

A pacemaker is a small device implanted in the chest to help control abnormal heart rhythms. However, in heart failure patients, a biventricular pacemaker (CRT) is often used to synchronize the contraction of the heart's lower chambers (the ventricles), improving the heart's efficiency.

Who Needs a Pacemaker for Heart Failure?

A CRT device may be recommended for patients with: - Heart failure with reduced ejection fraction (HFrEF), when the heart's pumping ability is significantly impaired. - A wide QRS complex (typically ≥120-150 milliseconds) on an ECG, which indicates poor electrical synchronization of the heart. - Persistent symptoms despite optimal medical therapy (such as beta-blockers, ACE inhibitors, and diuretics).

Benefits of a CRT Pacemaker

  • Improves heart function by coordinating the ventricles' contraction.
  • Reduces symptoms such as shortness of breath and fatigue.
  • Lowers hospitalization rates due to worsening heart failure.
  • Enhances quality of life and overall survival.

Risks and Considerations

While CRT pacemakers are generally safe, potential risks include: - Infection at the implant site. - Lead-related complications, such as displacement or malfunction. - Rare cases of bleeding or lung injury during the procedure.

Conclusion

For eligible patients with heart failure, a CRT pacemaker can be a life-changing intervention. It is important to consult with a cardiologist to determine if this therapy is appropriate based on clinical guidelines and individual health conditions.

Clinical Guidelines

Here are some relevant guidelines that provide more details on pacemaker therapy for heart failure:

Source recommendations

1. American College of Cardiology/American Heart Association Heart Failure Guidelines

  1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
  2. https://www.acc.org/Guidelines
  3. https://www.jacc.org/doi/10.1016/j.jacc.2023.12.024
  4. https://www.acc.org/education-and-meetings/products-and-resources/features/global-cv-institute/heart-failure-guidelines
  5. https://professional.heart.org/en/guidelines-and-statements

2. European Society of Cardiology Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure

  1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
  2. https://pubmed.ncbi.nlm.nih.gov/34447992/
  3. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Focused-Update-on-Heart-Failure-Guidelines
  4. https://academic.oup.com/eurheartj/article/42/36/3599/6358045
  5. https://pubmed.ncbi.nlm.nih.gov/27206819/

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