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    Heart-Failure Treatment by Device

    Technological breakthroughs are changing the course of heart-failure treatment -- but doubts remain about how many people will benefit in the near future.

    Implantable Cardioverter Defibrillators (ICDs) continued...

    Given that sudden cardiac death from fatal, abnormal heart rhythms causes about 50% of all heart-related deaths, ICDs have enormous potential. One recent study found that ICDs reduced sudden cardiac death in people at risk for it -- such as those with a previous heart attack or heart failure -- by more than 50%.

    Of course, there is a potential disadvantage to having an ICD for heart-failure treatment: If the experience of being shocked by a box in your chest doesn't sound pleasant, you're right. While some report minor discomfort, others find it extremely painful and anxiety-provoking. This is particularly troublesome in people who have frequent episodes of this potentially fatal abnormal heart rhythm.

    "There have been some studies [that] showed that after getting two shocks, people's anxiety went sky high," says Susan J. Bennett, DNS, RN, a professor in the Indiana University nursing school and a specialist in treating the condition. "But the other thing that happens is that some patients who get shocked are grateful because they know the device is working and they know that it saved their lives."

    ICDs can be implanted alone, but they are also combined with other devices, such as cardiac resynchronization therapy, for heart failure treatment.

    Cardiac Resynchronization Therapy (CRT)

    Cardiac resynchronization therapy is a new and promising treatment. "Resynchronization therapy is the biggest story in device therapy for heart failure," says Konstam, who is also president of the Heart Failure Society of America.

    In some patients with heart failure, the electrical signals that coordinate pumping of the different heart chambers become erratic, making the heart unable to pump blood efficiently. In addition, an already weakened heart wastes energy by fighting against itself.

    CRT devices deliver electrical impulses to both the right and left ventricles -- the two large, main pumping chambers of the heart -- restoring the coordination between the two sides of the heart and improving its function.

    Michael R. Bristow, MD, PhD, of the University of Colorado Health Sciences Center in Denver, was involved in one of the biggest studies of CRT ever done. Results were published in the May 2004 issue of The New England Journal of Medicine. Participants, all who had advanced heart failure, were divided into three groups: The first group got the best drug treatment -- a beta-blocker, an ACE inhibitor, and a diuretic -- while the second and third groups got the drug treatment plus either a CRT device or a CRT device with a defibrillator (the two devices now come together in one device). Researchers found that compared with aggressive medication treatment alone, adding CRT to treatment reduced the risk of death by 24%. Combining CRT with a defibrillator (the two devices now come together in one device) reduced deaths by 36%.

    "CRT makes you feel better, keeps you out of the hospital, and gives you a better quality of life," Bristow tells WebMD.

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