title: Roles and indications for use of implantable defibrillator and resynchronization therapy in the prevention of sudden cardiac death in heart failure.
abstract: Implantable devices are indicated in the primary and secondary prevention of potentially life-threatening ventricular tachyarrhythmias in patients with heart failure. Early studies, including the landmark MADIT trials, showed that implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices can play a significant role in aborting and preventing ventricular arrhythmias, respectively, that can cause sudden cardiac death. To this day, there have been a number of randomized controlled trials, with respective substudy analyses, that have attempted to better understand the indications for these interventions in patient care. Here, we summarize the major results of these studies, and we discuss the role of ICD therapy for both ischemic and non-ischemic cardiomyopathy, emerging evidence in support of wearable defibrillators, and the impact of modified ICD programming strategies on patient outcomes. Regarding CRT therapy, the phenomenon of ventricular reverse remodeling is an important prognostic indicator in preventing future ventricular tachyarrhythmia episodes. In summation, we provide an overview of the possible selection criteria that can be used in identifying appropriate patients for ICD and/or CRT therapy, as supported by the data.
authors.affiliation: Heart Research Follow-Up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, 265 Crittenden Blvd., PO Box 653, Rochester, NY, 14642, USA. yitschak.biton@heart.rochester.edu.|Sheba Medical Center, Ramat Gan, and Sackler School of Medicine, Heart Institute, Tel Aviv University, Tel Aviv, Israel. yitschak.biton@heart.rochester.edu.
authors.forename: Yitschak
authors.initials: Y
authors.lastname: Biton
authors.affiliation: University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
authors.forename: Jayson R
authors.initials: JR
authors.lastname: Baman
authors.affiliation: Heart Research Follow-Up Program, Division of Cardiology, Department of Medicine, University of Rochester Medical Center, 265 Crittenden Blvd., PO Box 653, Rochester, NY, 14642, USA.
authors.forename: Bronislava
authors.initials: B
authors.lastname: Polonsky
mesh_terms: D001145:Arrhythmias, Cardiac / Q000150:complications*; D058406:Cardiac Resynchronization Therapy / Q000379:methods / Q000592:standards*; D058409:Cardiac Resynchronization Therapy Devices; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D017410:Practice Guidelines as Topic; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D020257:Ventricular Remodeling
keywords: Cardiac resynchronization therapy; Device therapy; Heart failure; Implantable cardioverter–defibrillator; Indications; Long-term outcomes; Primary and secondary prevention; Sudden cardiac death; Ventricular arrhythmia