Heart Failure 2024: Joining forces to achieve optimal use of Cardiac Rhythm Management devices

SMART REPLAY - A new symposium format including interactive case-based discussions!

Held during the recent Heart Failure congress in Lisbon (May 11^th to 14^th 2024), this symposium highlights the role of cardiac rhythm management devices as a cornerstone in HF care.

Prof Mullens chaired the symposium and presented 2 clinical cases which led to great interactive discussions from the panel of HF and EP experts (Prof Bozkurt, Prof Israel, Prof Russo and Prof Witte).

Case presentation 1: Prevention of sudden arrhythmic death in HFrEF – who needs an implantable cardioverter defibrillator ?

Case presentation 2: Cardiac resynchronization therapy in HFrEF – for whom, and when?

There is clear consensus from these EP and HF experts that cardiac rhythm management

devices are part of the comprehensive management of HFrEF and should be initiated as soon as possible in indicated patients.

• Prof Mullens said that “HF patients live longer today with good medical therapy, but some are still at a risk of sudden cardiac death and need an ICD. ICDs still save lives”.

• Prof Bozkurt insisted that “For indicated patients, use the guideline verbiage when recommending an ICD: you should get an ICD! (….) In the US, since 2012, despite all the guidelines & advances in medical therapies, we are seeing a rise in mortality, so it is critical for us to recognize that guidelines directed therapies include devices in addition to medications”.

• Prof Israel mentioned that “Heart Failure treatment is optimal if you include all the options available - medications & devices - and if you include all the specialists (HF, EP, imaging etc…)”

• Prof Russo reminded that “Underutilization of ICD is 50% in eligible patients in some of the registry studies. We think we are not doing well enough in prescribing ICD therapy. We can do better! (…) We need a team approach between HF and EP and taking care of these complex patients to improve outcomes”.

• Prof Witte stated that “CRT is incredibly effective, it has an amazing result for many of our patients and indications are easy: symptomatic HF, LV dysfunction and a broad QRS. This is the easiest thing in the world! Do not let a patient walk out of your office with these features without having considered and already referred or a CRT device!”

Overall, the symposium provided valuable insights into the use of cardiac rhythm management devices in heart failure, emphasizing the importance of timely identification & referral of indicated patients to improve outcomes and quality of life. The right patient for the right therapy at the right time.