Article Summary

1. Implantable devices can help treat heart failure at the point where medications can fall short
2. Left bundle branch pacing (LBBP) and Cardiac Contractility Modulation (CCM) are two therapeutic options that can make a difference in patients’ heart failure symptoms
3. The data that such devices provide can help physicians better understand and manage their patients’ heart failure in real time

Even with gold-standard treatment, heart failure causes tremendous distress in patients, with debilitating symptoms and pain that can impact their day-to-day functioning, social relationships, and mental health. Studies have found that the quality of life for heart failure patients is comparable to people on dialysis, and five-year survival estimates are on par with some cancers.

It’s clear that existing medications sometimes aren’t enough to help these patients, says Isaac R. Whitman, MD, associate professor of cardiac electrophysiology at the Lewis Katz School of Medicine at Temple University.

“We have to be open to other types of therapy in their treatment, and that would include devices,” he says.

A Novel Approach to Pacing

Left bundle branch pacing (LBBP) is a new approach that works by directly activating the conduction system of the heart. Whitman noted that this approach can correct a left bundle branch block more effectively than traditional biventricular pacing. But he recommends considering LBBP even in patients who don’t need it, noting that it outperforms traditional pacemakers.

It also requires less maintenance and fewer program updates than traditional pacemakers, he adds.

Treating Heart Failure with Other Implantable Devices

Other devices look like pacemakers, but work by delivering therapeutic doses of electricity to the heart.

Patients with class 3 or 4 heart failure may be candidates for Cardiac Contractility Modulation, an implant that delivers high-output electrical therapy during the absolute refractory period. This therapy works by stimulating an increase in intracellular systolic calcium, which improves the heart’s muscle cells to squeeze.

“It acts like a pharmaceutical agent,” Whitman says.

Baroreflex Activation Therapy (BAT) could be an option for patients with an ejection fraction below 35%, he adds. This treatment works by stimulating the baroreceptor to downregulate sympathetic activity and increase vagal tone.

Advanced Diagnostics Can Guide Treatment

Other devices provide remote monitoring or diagnostic capabilities, including pulmonary artery pressure sensors and ICD sensors.

But while these devices have been shown to reduce hospitalizations, Whitman stresses that they are interventions -- not therapies. They are only effective when providers use them to monitor patients for subtle signs of escalation and act quickly with preventative treatment.

“Data that isn’t acted upon is useless data,” he notes.

Whitman shares more tips and insights in his full presentation, “Rise of the Machines: New Devices in Heart Failure,” linked above.