The Year in Cardiology

Heart Failure: the Year in Cardiology 2019

John G.F. Cleland; Alexander R. Lyon; Theresa McDonagh; John J.V. McMurray

Disclosures

Eur Heart J. 2020;41(12):1232-1248. 

In This Article

Implanted Electrical Devices

The controversy over the role of high-energy devices for heart failure continues. Long-term follow-up of cardiac resynchronization therapy (CRT) in a French Registry showed a low rate of sudden death amongst patients who received CRT-Pacing (without a defibrillator).[57–59] A systematic review of observational studies and RCTs reported that differences in the rate of sudden death with CRT-Pacing and CRT-D were narrowing.[58] RCTs comparing CRT-Pacing and CRT-D are underway[59] (Take home figure). Whether myocardial scar found on cardiac magnetic resonance imaging identifies patients with more to gain from an implantable cardioverter defibrillator (ICD) is also under investigation[60] (CMR_GUIDE; https://clinicaltrials.gov/ct2/show/NCT01918215). Retrospective analysis of SCD-HeFT found that patients with T2DM did not benefit from an ICD.[61] An individual patient-data meta-analysis confirmed a reduction in sudden death with MRA.[62] A systematic review identified 22 studies with post-mortem interrogation of ICDs; the analysis suggested that 24% of sudden deaths were not arrhythmic.[63] A substantial multi-point pacing trial failed, so far, to show improvements in the clinical or echocardiographic response to CRT.[64]

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