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Posts Tagged ‘when should i use combo device ?’

  • CRT -Cardiac resynchronisation is done  by putting multiple wires and electrically organizing the contraction  sequence and improving mechanical function.
  • ICD-Implantable cardiovertor defibrillator shocks whenever VT or VF occur and suden death is prevented.
  • CRT-D (Combo device which functions as both )

CRT is done for advanced heart failure to improve exercise capacity and hence the quality of life .It does not do any thing significant in prolonging life .ICD is again implanted  in advanced LV dysfunction with either documented VT/VF or patients who are at  propensity for VT .It has dramatic benefit in preventing  sudden cardiac death.

Both CRT and ICD has some overlapping indication in cardiac failure. Attention young cardiologists,   please realise among these two the value of ICD is many  many  fold higher than CRT.This fact is rarely discussed and disseminated.

 True benefits of CRT is realised only when it is combined with ICD.

Summary

  • Ideally all advanced cardiac failure patients should receive both ICD and CRT (CRT-D)
  • ICD as stand alone therapy has a  distinct role in patients with severe LV dysfunction (LV EF<30%) without  wide QRS in ECG
  • There is no role for  CRT  as a standalone procedure in cardiac failure  .it should  always  be combined with ICD (ie CRT-D) *

*Except  in patient with  degenerative complete heart block , both ventricles are paced  the term Bi-Vi pacing is used  instead of CRT.Since LV function is normal here , there is no de-synchrony in the first place .The synchronised  BIVI pacing is meant to prevent future heart failure

Final message

Always use a combo device in advanced symptomatic heart failure which  is refractory to medical therapy.

After all , there need to be a life in the first place  so that we can improve it . ICD ensures life while  CRT tries to improve it.

http://europace.oxfordjournals.org/content/14/9/1236.long

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