New pacing technologies for heart failure

Abstract

Introduction The prevalence of heart failure in the general population is estimated to be 1-2% and increases rapidly with age.1 In developed countries heart failure is a leading cause of admission to hospital among elderly patients and accounts for 1-2% of healthcare expenditure.2 Although several pharmacological treatments have improved outcome,3–5 the prognosis of patients with heart failure remains poor. Alternative non-pharmacological approaches including cardiac transplantation have been limited by availability of organs, and the use of artificial left ventricular assist devices remains restricted. Recently, several promising new developments have taken place in pacing technology to treat selected patients with heart failure. These include atrio-biventricular pacing to correct abnormal patterns of left ventricular contraction and implantable cardiac defibrillators for treatment of malignant ventricular arrhythmias. As the scale of the problem becomes apparent new treatments that have been shown to improve morbidity and possibly mortality in patients with chronic heart failure will undoubtedly have a major impact on clinical practice and healthcare resources. Footnotes Competing interests AWCC has received reimbursement from many companies for attending conferences. REL receives a research fellowship from Medtronic Inc and has received reimbursement from many companies for attenting conferences. MRC is the clinical adviser for the national clinical guidelines on the management of heart failure, commissioned by the National Institute for Clinical Excellence, but the opinions in this review are his own and will not necessarily reflect those in the forthcoming guideline. MRC has received honorariums for advisory boards and lectures related to treatments mentioned in this review.