Cardiac Electronic Implantable Devices in the Treatment of Heart Failure

Heart failure is a condition which has an increasing incidence as the population ages, leading to increasing prevalence globally and in Australia. This condition also carries very high morbidity and mortality rates, attributed in part to electrical conduction disturbances which lead to sudden cardiac death or pathophysiological cardiac changes due to delayed activation of the left free wall and mechanical dyssynchrony. Current pharmacologic therapy has made impressive advances in improving survival rates in this population, but morbidity and mortality rates still remain high. Additionally, there is also a population of heart failure patients on optimal medical therapy who still suffer from functionally debilitating symptoms of heart failure. Device therapy comprising of implantable cardioverter-defibrillator (ICD) and cardiac resynchronisation therapy (CRT) are used to treat heart rhythm disturbances in a broad range of patients with heart disease and have now become established therapies in patients with heart failure receiving standard medical therapy. This review examines current evidence for the use of implantable cardioverter-defibrillators in the reduction of sudden cardiac death in patients with advanced systolic dysfunction and the use of cardiac resynchronisation therapy in improving ventricular performance as well as mortality and morbidity rates.