ABSTRACT
This chapter reviews implantable devices for treatment and monitoring of heart failure. Implantable cardioverter-defibrillators, effective in terminating malignant arrhythmias, have class I indication for the prevention of sudden cardiac death in cardiomyopathy. Improvement in cardiovascular efficiency and hemodynamics can be achieved with device therapy which targets ventricular dyssynchrony or valvular regurgitation. Cardiac resynchronization therapy, cardiac contractility modulation, and transcatheter mitral valve repair devices are examples of device-based technologies that have been shown to decrease heart failure morbidity or mortality. Sympathetic overdrive is known for its deleterious role in heart failure. Device-based strategies to overcome sympathetic activity include baroreceptor activation therapy and spinal cord and vagus nerve stimulation. These therapies are currently experimental. The clinical conundrum of intracardiac filling pressures rising in advance of patients feeling symptoms has led to the emergence of implantable devices for ambulatory heart failure monitoring. These devices have focused on the monitoring of impedance, pulmonary artery, right ventricle, and left atrial pressures. Interatrial shunting is an investigational approach that shunts blood from the high pressure left atrium to the right atrium, thus decompressing the left atrium pressure and in the process attenuating symptoms and signs of heart failure.
