Expanding indications for pacing in chronic heart failure

Henry Krum and Prashanthan Sanders
Med J Aust 2009; 190 (9): . || doi: 10.5694/j.1326-5377.2009.tb02520.x
Published online: 4 May 2009

Do you have patients who could benefit from therapeutic pacing and defibrillator devices?

In recent years, management of chronic heart failure has advanced considerably, especially the optimisation of key pharmacological strategies (angiotensin-converting enzyme inhibitors, β-blockers) and multimodal management. In parallel, there has been a quieter revolution: the use of therapeutic pacing and defibrillator devices in patients with heart failure has moved from experimental and clinical research to everyday clinical practice. Milestones include landmark trials establishing the definitive mortality benefit of implantable defibrillators in ischaemic cardiomyopathy,1 the clinical utility of electronically synchronising contraction of both ventricles,2 and mortality benefits of cardiac resynchronisation therapy (CRT).3 Nonetheless, therapeutic pacing and defibrillator devices appear to be underutilised,4 perhaps due to lack of awareness of their clinical benefits and concerns regarding cost.

  • Henry Krum1
  • Prashanthan Sanders2,3

  • 1 Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC.
  • 2 University of Adelaide, Adelaide, SA.
  • 3 Royal Adelaide Hospital, Adelaide, SA.

Competing interests:

Henry Krum has received fees from BIOTRONIK as he is an Executive Committee member for the EchoCRT study. Prashanthan Sanders has served on advisory boards of, and received lecture fees and research funding from, St Jude Medical, Medtronic, Bard Electrophysiology and Biosense Webster.


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