The 2021 ESC guidelines updated electrotherapy indications in heart failure, downgrading ICDs for primary prevention in non-ischemic etiology and CRT for LBBB with QRS 130-149 ms to class IIa.
The 2021 ESC guidelines updated indications for electrotherapy in heart failure, including downgrading ICD for primary prevention in non-ischemic HF and refining CRT criteria.
In 2021 European Society of Cardiology published guidelines on diagnosis and therapy of heart failure and guidelines on cardiac pacing and cardiac resynchronization therapy. In patients with heart failure, the indications for electrotherapy were newly defined. In the guidelines, the class of recommendations related to ICD implantation in primary prevention of sudden cardiac death in patients with heart failure of non-ischemic aetiology were decreased from I to IIa. This recommendation reflects the results of DANISH study. The detailed analysis of the trial as well as meta-analysis of huge trials in this topic and recent publications in this field seemed not to support this change. These recent trials also showed a much lower risk of death in current patients with heart failure. In the field of resynchronization therapy, the class of indication was deceased from I to IIa in patients with reduced ejection fraction, LBBB and QRS duration of 130-149 ms. Scientific data unquestionable justify such an approach. Resynchronization therapy should also be introduced in patients with LVEF ≤50%, in whom the expected percentage of ventricular pacing is high. Benefits could be observed even in patients with 20% or higher RV pacing. Upgrade of the standard pacemaker or ICD do CRT system should be considered in patients after initial implantation in whom during follow up hemodynamic deterioration is observed. Indications for CRT in patients with atrial fibrillation were left the same as in guidelines published in 2016. In the case of AV node ablation to rate control in subjects with AF CRT should be implanted in patients with HFrEF and should be considered in those with HFmrEF. APAF-CRT trial proved that rate control in AF by AV node ablation and CRT implantation is characterized by the better outcome as compared to medical therapy and surely will find its place in future guidelines.
Przemysław Mitkowski (Thu,) conducted a review in Heart failure. Electrotherapy (ICD, CRT) was evaluated. The 2021 ESC guidelines updated electrotherapy indications in heart failure, downgrading ICDs for primary prevention in non-ischemic etiology and CRT for LBBB with QRS 130-149 ms to class IIa.