Role and Indications for Device Therapies in Heart Failure: Condensed Summary

Authors

  • Eileen O’Meara, MD Montreal Heart Institute, Montreal QC.Universite de Montreal, Montreal, QC
  • Blandine Mondésert, MD, FCHRS Montreal Heart Institute, Montreal, QC

DOI:

https://doi.org/10.58931/cct.2025.127

Abstract

Over the past decade, the substantial benefits associated with current guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF) have been brought into the light, as emphasized in a recent publication from our institution. Despite these advances, device therapy continues to hold an important place in treating heart failure (HF), both for left ventricular (LV) remodeling (and associated prognosis) as well as for preventing sudden cardiac death (SCD).

Cardiac resynchronization therapy (CRT) is a key intervention in heart failure (HF) management, particularly for patients with left bundle branch block (LBBB), which is observed in 15–25% of patients with HF, and is associated with reduced left ventricular function. CRT helps in correcting dyssynchronous ventricular contraction leading to impaired cardiac output. Although less prevalent, right bundle branch block (RBBB) and nonspecific interventricular conduction delay (IVCD) are also associated with adverse remodelling, including increased right ventricular volumes and reduced function.

Author Biographies

Eileen O’Meara, MD, Montreal Heart Institute, Montreal QC.Universite de Montreal, Montreal, QC

Dr. Eileen O’Meara is a professor at Université de Montréal and at the MontrealHeart Institute. She completed a Fellowship in Heart Failure, and another in Stress Echocardiography. She holds the MHI Carolyn and Richard J Renaud’s research chair in Heart Failure and is the co-director of the Myocardial Research Axis at MHI. She is a member of the Internal Review Board, of the Research Core Echocardiography Laboratory and of the Pharmacology Committee at MHI, as well as Chief of Outpatients Clinics at MHI. She was Co-Chair of the Primary Panel for the Canadian Cardiovascular Society and Canadian Heart Failure Society (CCS and CHFS) HF Guidelines and co- chair of the Cardiorenal Protection Guidelines for the CCS/CHFS (2020-2022). She is a section lead for the soon to be published CCS HFpEF guidelines. Her research focuses on cardio-kidney-inflammation interactions and fibrosis in HF, including circulating and cardiac imaging biomarkers; as well as on comorbid conditions that contribute to HF, more specifically diabetes/adiposity, CKD, anemia and arrhythmia. She is involved in several large HF clinical trials as a National Lead Investigator, SC or EC member.

Blandine Mondésert, MD, FCHRS, Montreal Heart Institute, Montreal, QC

A French cardiologist who graduated from the University of Grenoble in 2008, Dr. Blandine Mondésert worked for two years as a senior arrhythmia clinician at the Grenoble University Hospital in France. She was also recognized as a cardiologist by the Collège des Médecins du Québec, through the France-Quebec agreements in July 2013. She subsequently completed a fellowship in electrophysiology at the Montreal Heart Institute between 2011 and 2013, where she specialized in the fields of electrophysiology (pacing and ablation), particularly in adult patients with congenital heart disease, within Dr. Paul Khairy’s team. She also developed expertise in the extraction of implantable cardiac equipment, for which she completed her extraction training at the Lille University Hospital in France in 2014. In July 2014, Dr. Blandine Mondésert joined the team at the Montreal Heart Institute, where she works as a cardiologist. She also serves as an assistant clinical professor of medicine at the University of Montreal.

References

Jarjour M, Leclerc J, Bouabdallaoui N, Ahnadi C, Brouillette D, de Denus S, et al. Optimization of pharmacotherapies for ambulatory patients with heart failure and reduced ejection fraction is associated with improved outcomes. Int J Cardiol. 2023;370:300-308. doi:10.1016/j.ijcard.2022.09.058 DOI: https://doi.org/10.1016/j.ijcard.2022.09.058

Abe TA, Evbayekha EO, Jackson LR 2nd, Al-Khatib SM, Lewsey SC, Breathett K. Evolving indications, challenges and advances in cardiac resynchronization therapy for heart failure. J Card Fail. Published online April 16, 2025. doi:10.1016/j.cardfail.2025.01.031 DOI: https://doi.org/10.1016/j.cardfail.2025.01.031

Cleland JG, Daubert JC, Erdmann E, Erdmann E, Freemantle N, Gras D, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352(15):1539-1549. doi:10.1056/NEJMoa050496 DOI: https://doi.org/10.1056/NEJMoa050496

Bristow MR, Saxon LA, Boehmer J, Kreuger S, Kass DA, De Marco T, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350(21):2140-2150. doi:10.1056/NEJMoa032423 DOI: https://doi.org/10.1056/NEJMoa032423

Exner DV, Birnie DH, Moe G, Thibault B, Philippon F, Healey JS, et al. Canadian Cardiovascular Society guidelines on the use of cardiac resynchronization therapy: evidence and patient selection. Can J Cardiol. 2013;29(2):182-195. doi:10.1016/j.cjca.2012.10.006 DOI: https://doi.org/10.1016/j.cjca.2012.10.006

Chung MK, Patton KK, Lau CP, Dal Forno ARJ, Al-Khatib SM, Arora V, et al. 2023 HRS/APHRS/LAHRS guideline on cardiac physiologic pacing for the avoidance and mitigation of heart failure. Heart Rhythm. 2023;20(9):e17-e91. doi:10.1016/j.hrthm.2023.03.1538 DOI: https://doi.org/10.1016/j.hrthm.2023.03.1538

Glikson M, Nielsen JC, Kronborg MB, Michowitz Y, Auricchio A, Barbash IM, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42(35):3427-3520. doi: 10.1093/eurheartj/ehab364. DOI: https://doi.org/10.1093/eurheartj/ehab699

Leyva F, Zegard A, Patel P, Stegemann B, Marshall H, Ludman P, et al. Improved prognosis after cardiac resynchronization therapy over a decade. Europace. 2023;25(6):euad141. doi:10.1093/europace/euad141 DOI: https://doi.org/10.1093/europace/euad141

Chi WK, Gong M, Bazoukis G, Yan BP, Letsas KP, Liu T, et al. Impact of coronary artery chronic total occlusion on arrhythmic and mortality outcomes: a systematic review and meta-analysis. JACC Clin Electrophysiol. 2018;4(9):1214-1223. doi:10.1016/j.jacep.2018.06.011 DOI: https://doi.org/10.1016/j.jacep.2018.06.011

Mullens W, Dauw J, Gustafsson F, Mebazaa A, Steffel J, Witte KK, et al. Integration of implantable device therapy in patients with heart failure. A clinical consensus statement from the Heart Failure Association (HFA) and European Heart Rhythm Association (EHRA) of the European Society of Cardiology (ESC). Eur J Heart Fail. 2024;26(2):483-501. doi:10.1002/ejhf.3150 DOI: https://doi.org/10.1002/ejhf.3150

Knops RE, Lloyd MS, Roberts PR, Wright DJ, Boersma LVA, Doshi R, et al. A modular communicative leadless pacing-defibrillator system. N Engl J Med. 2024;391(15):1402-1412. doi: 10.1056/NEJMoa2401807 DOI: https://doi.org/10.1056/NEJMoa2401807

Friedman P, Murgatroyd F, Boersma LVA, Manlucu J, Knight BP, Clementy N, et al. Performance and safety of the extravascular implantable cardioverter defibrillator through long-term follow-up: final results from the Pivotal study. Circulation. 2025;151:322–332. doi:10.1161/CIRCULATIONAHA.124.071795 DOI: https://doi.org/10.1161/CIRCULATIONAHA.124.071795

Okada DR, Smith J, Derakhshan A, Gowani Z, Misra S, Berger RD, et al. Ventricular arrhythmias in cardiac sarcoidosis. Circulation. 2018;138(12):1253-1264. doi:10.1161/CIRCULATIONAHA.118.034687 DOI: https://doi.org/10.1161/CIRCULATIONAHA.118.034687

Boulet J, Massie E, Mondésert B, Lamarche Y, Carrier M, Ducharme A. Current review of implantable cardioverter defibrillator use in patients with left ventricular assist device. Curr Heart Fail Rep. 2019;16(6):229-239. doi: 10.1007/s11897-019-00449-8 DOI: https://doi.org/10.1007/s11897-019-00449-8

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Published

2025-09-29

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1.
O’Meara E, Mondésert B. Role and Indications for Device Therapies in Heart Failure: Condensed Summary. Can Cardiol Today [Internet]. 2025 Sep. 29 [cited 2025 Oct. 4];1(2):15–21. Available from: https://canadiancardiologytoday.com/article/view/1-2-OMeara_et_al

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Volume 1, Issue 2, Summer 2025

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