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CRT or CRT-D devices? The case for ‘high energy’ devices

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Abstract

The decision to implant a CRT or CRT-D device is an important one that requires a careful look at the patient and discussion with the patient as to the benefits and risks associated with each approach. The good news is that CRT provided in any device is a robust therapy that improves many measures of heart failure outcome in very high-risk patients. We argue that in most circumstances, it is much easier to turn a tachycardia device off than not to have the benefit of prompt defibrillation should a tachycardia event occur. While cost is always a consideration, the responsibility of the physician is to individualize patient care and advocate for each patient, based upon the best available therapies.

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References

  1. Saxon LA (2006) More is better with cardiac resynchronization therapy—but is it enough? Eur Heart J 27:1891–1892

    Article  PubMed  Google Scholar 

  2. Hopkins B, Ketner L, Kobrin E (2010) MDT & Medtech: thoughts post a tough Q1. Bank of America Merrill Lynch: Medical Technology. pp 1–15

  3. Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, Ellestad M, Trupp RJ, Underwood J, Pickering F, Truex C, McAtee P, Messenger J, MIRACLE Study Group (2002) Cardiac resynchronization in chronic heart failure. N Engl J Med 346:1845–1853

    Article  PubMed  Google Scholar 

  4. Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, DeVries DW, Feldman AM (2004) Comparison of medical therapy with or without an implantable defibrillator in advanced cardiac heart failure. N Engl J Med 350:2140–2150

    Article  PubMed  CAS  Google Scholar 

  5. Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L, Cardiac Resynchronization-Heart Failure (CARE-HF) Study Investigators (2005) The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 352:1538–1549

    Article  Google Scholar 

  6. Cleland JGF, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, Tavazzi L (2006) Longer-term effects of cardiac resynchronization therapy on mortality in heart failure [the CArdiac REsynchronziation-Heart Failure (CARE-HF) trial extension phase]. Eur Heart J 27:1928–1932

    Article  PubMed  Google Scholar 

  7. Vanderheyden M, Mullens W, Delrue L, Goethals M, de Bruyne B, Wijns W, Gellen P, Verstreken S, Wellens F, Bartunek J (2008) Myocardial gene expression in heart failure patients treated with cardiac resynchronization therapy. J Am Coll Cardiol 51:129–136

    Article  PubMed  CAS  Google Scholar 

  8. Saxon LA, Bristow M, Boehmer J, Krueger S, Kass D, De Marco T, Carson P, DiCarlo L, Feldman A, Galle E, Echlund F (2006) Predictors of sudden cardiac death and appropriate shock in the COMPANION Trial. Circulation 114:2766–2772

    Article  PubMed  Google Scholar 

  9. Adamson PB, Smith AL, Abraham WT, Kleckner KJ, Stadler RW, Shih A, Rhodes MM, InSync III Model 8042 and Attain OTW Lead Model 4193 Clinical Trial Investigators (2004) Continuous autonomic assessment in patients with symptomatic heart failure: prognostic value of heart rate variability measured by an implanted cardiac resynchronization device. Circulation 110:2389–2394

    Article  PubMed  Google Scholar 

  10. Carson P, Anand I, O’Connor C, Jaski B, Steinberg J, Lwin A, Lindenfeld J, Ghali J, Barnet JH, Feldman AM, Bristow MR (2005) Mode of death in advanced heart failure: the comparison of medical, pacing, and defibrillation therapies in heart failure (COMPANION) trial. J Am Coll Cardiol 46:2329–2334

    Article  PubMed  Google Scholar 

  11. Epstein AE, Dimarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO (2008) American College of Cardiology/American Heart Association Task Force on Practice; American Association for Thoracic Surgery; Society of Thoracic Surgeons. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: executive summary. Circulation 5:934–955

    Google Scholar 

  12. Feldman AM, de Lissovoy G, Bristow MR, Saxon LA, De Marco T, Kass DA, Boehmer J, Singh S, Whellan DJ, Carson P, Boscoe A, Baker TM, Gunderman MR (2005) Cost effectiveness of cardiac resynchronization therapy in the comparison of medical therapy, pacing, and defibrillation in heart failure (COMPANION) trial. J Am Coll Cardiol 46:2311–2321

    Article  PubMed  Google Scholar 

  13. Ellenbogen KA, Saxon LA (2004) Clinical trials of resynchronization therapy. In: Ellenbogen KA, Kay GN, Wilkoff BL (eds) Device therapy for congestive heart failure. Elsevier, Philadelphia, pp 47–91

    Google Scholar 

  14. Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS, Daubert JP, Higgins SL, Brown MW, Andrews ML, Multicenter Authomatic Defibrillator Implantation Trial II Investigators (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Eng J Med 346:877–883

    Article  Google Scholar 

  15. Saxon LA, Hayes DL, Day J, Gilliam FR, Heidenreich PA, Seth M, Meyer TE, Boehmer JP (2009) Survival after ICD and CRT-D implant in a large cohort of heart failure patients treated with contemporary drug and device therapies—results of the ALTITUDE study. In: Heart Rhythm 2009, 30th Annual Scientific Session—Late Breaker. Available from: http://www.hrsonline.org/News/Media/press-releases/upload/altitude_abstract.pdf

  16. Willkoff BL, Johnson JW, Ousdigian KT, Gillberg JM, Fischer A (2010) Programming strategies associated with shock reduction in 88,804 implantable defibrillator patients. In: Heart Rhythm 2010, 31st Annual Scientific Session—Late Breaker. Available from: http://www.hrsonline.org/News/Media/press-releases/upload/Programming-Strategies-Associated-with-Shock-Reduction.pdf

  17. Saxon LA, Hayes DL, Gilliam FR, Heidenreich PA, Day J, Seth M, Meyer TE, Jones PW, Boehmer JP (2010) Long-term outcome after ICD and CRT implant and the influence of remote device follow-up: the ALTITUDE survival study. Circulation 122:2359–2367

    Article  PubMed  Google Scholar 

  18. Shah A, Bhavnani S, Guertin D, Coleman C, Clyne C, Yarlagadda R, Kluger J (2008) ICD and shock experience in dialysis patients. Circulation 118:835–836

    Google Scholar 

  19. Stevenson LW, Desai AS (2006) Selecting patients for discussion of the ICD as primary prevention for sudden death in heart failure. J Card Fail 12:407–412

    Article  PubMed  Google Scholar 

  20. Saxon LA (2006) Patient selection for primary prevention ICD’s—are EPS shocking patients into consent? J Card Fail 12:413–415

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Cardiovascular Thoracic Institute, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 322, Los Angeles, CA, 90033, USA

    Leslie A. Saxon

  2. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA

    Bruce L. Wilkoff

Authors
  1. Leslie A. Saxon
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  2. Bruce L. Wilkoff
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Correspondence to Leslie A. Saxon.

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Saxon, L.A., Wilkoff, B.L. CRT or CRT-D devices? The case for ‘high energy’ devices. Heart Fail Rev 17, 777–779 (2012). https://doi.org/10.1007/s10741-011-9276-9

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  • DOI: https://doi.org/10.1007/s10741-011-9276-9

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