Implantable Cardiac Defibrillator (ICD):
- Recommended for HF patients who have EF ≤35% with NYHA class II-III on chronic optimal medical therapy and who have reasonable expectation of survival with a good functional status for more than 1 year for primary prevention of SCD (spontaneous cardiac death – from arrhythmia, like Vfib).
- Patients should receive at least 3 months of optimal medical therapy prior to reassessment of EF and implantation of an ICD.
Cardiac Resynchronization Therapy (CRT) or Biventricular pacing:
- Beneficial in patients with an EF of ≤35%, NYHA class III-IV HF despite optimal medical therapy and conduction abnormalities, wide QRS ≥150 ms (left bundle branch block and atrioventricular delay.
- Improve quality of life and reduce the risk of death in carefully selected patients.
- Pacing leads for cardiac resynchronization therapy (CRT):
- Two leads (right atrial and right ventricular leads) permit pacing of the right atrium and right ventricle.
- The third lead (coronary sinus lead), which is advanced through the coronary sinus into a venous branch that runs along the free wall of the left ventricle, paces the lateral wall and enables synchronized left ventricular contraction.
Intra-aortic balloon pump (IABP): Can be considered for patients in whom other therapies have failed, have transient myocardial dysfunction, or are awaiting a definitive procedure such as transplantation.
Left Ventricular Assist Device: LVAD