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Invasive Treatments
Common Procedures:
Electrophysiological testing
Pacemaker implantation
Cardiac catheterization
Revascularization
Angioplasty
Stenting
Heart valve repair/replacement
Correction of congential heart defects
Coronary artery bypass
Heart transplantation
According to the Scientific Registry of Transplant Recipients, at the beginning of 2001 there were 4106 people on the heart transplant list. By the end of the year the list had 4097 people on it. During the year 623 patients died while waiting for a heart, and another 139 deteriorated to the point that they were no longer eligible for a transplant. [28]
Ultrafiltration [28]
A form of continuous renal replacement therapy (CRRT)
Removes fluid overload
Unlike some other mechanisms, this does not remove solutes such as protein, platelets and other large molecules
Can remove up to 500ml of fluid per hour
Implanted Devices
It has been suggested that any patient who has a LVEF of less than 30% receive an implanted cardioverter-defibrillator (ICD) [29][30]. Unfortunately the cost of this device, including hospital fees can exceed $40,000.
Left ventricular assistive devices [28]
Used clinically since the late 1970’s
Used to bridge the time to heart transplant
Can be made much smaller now, and can be implanted into patients
Potential complications: infection, bleeding, neurologic complications, device malfunction
Cardiac Resynchronization Therapy (CRT) has been shown to optimize atrial-ventricular delay and narrow the QRS duration.
Uses an implanted biventricular Pacemaker
(One pacemaker is placed on the back of the heart, in the coronary vein, the other on the left ventricle [1])
Improves contraction coordination
- Often combined with an ICD [1]
National Heart, Lung and Blood Institute, NIH, USA Results in improved QoL and functional capacity in patients with LV dysynchrony.
Resulted in a 50% reduction in the risk of hospitalization
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1. http://www.emedicinehealth.ca
28. Trupp RJ, Abraham WT. Nonpharmacologic Options for the Management of Heart Failure. Current Cardiology Reports. 2003;5:243-246.
29. Bardy GH, Lee KL, Mark DB, et al, and the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005;352(3):225-37.
30. Greenberg H, Case RB, Moss AJ, Brown MW, Carroll ER, Andrews MC, and the MADIT-II Investigators. Analysis of mortality events in the Multi-Center Automatic Defibrillator Implantation Trial (MADIT-II). J Am Coll Cardiol. 2004;43(8):1459-65.
