Cardiovascular Implantable Electronic Device Therapies for Chronic Heart Failure

Cardiovascular implantable electronic devices (CIEDs) are essential in the management of chronic heart failure, which remains a major cause of morbidity and mortality despite guideline-directed medical therapy. By targeting mechanisms beyond pharmacological control, CIEDs improve outcomes through resynchronization, arrhythmia prevention, and contractility modulation. Cardiac resynchronization therapy enhances ventricular synchrony, with conduction system pacing emerging as a physiological alternative to biventricular pacing. Implantable cardioverter-defibrillators remain central to the prevention of sudden cardiac death, while sub-cutaneous implantable cardioverter-defibrillators extend options for patients with limited venous access or an elevated infection risk. Cardiac contractility modulation represents an innovative approach for moderate ventricular dysfunction, augmenting contractility without inducing arrhythmias. Collectively, these therapies complement medical treatment and highlight the importance of individualized, patient-centered strategies to improve survival, functional capacity, and quality of life in patients with heart failure, underscoring the expanding clinical relevance of CIEDs.