IMR Press / RCM / Volume 22 / Issue 2 / DOI: 10.31083/j.rcm2202047
Open Access Review
Contemporary management of heart failure patients with reduced ejection fraction: the role of implantable devices and catheter ablation
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1 Electrophysiology Department, Barts Heart Centre, St. Bartholomew’s Hospital, EC1A 7BE London, UK
2 Medical School, National and Kapodistrian University of Athens, 10679 Athens, Greece
3 Section of Heart Failure and Transplant Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
4 Heart Imaging Centre, Royal Brompton & Harefield NHS Foundation Trust, SW3 6NR London, UK
5 3rd Department of Cardiology, “Sotiria” Hospital University of Athens Medical School, 11527 Athens, Greece
6 Department of Cardiac Electrophysiology, Essex Cardiothoracic Centre, SS16 5NL Basildon, UK
7 Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Anglia Ruskin University, CM1 1SQ Chelmsford, UK
8 Institute of Cardiovascular Science, University College London, WC1E 6BT London, UK
Academic Editor: Peter A. McCullough
Rev. Cardiovasc. Med. 2021, 22(2), 415–428;
Submitted: 8 March 2021 | Revised: 27 May 2021 | Accepted: 9 June 2021 | Published: 30 June 2021

Heart failure (HF) is a complex clinical syndrome characterised by significant morbidity and mortality worldwide. Evidence-based therapies for the management of HF include several well-established neurohormonal antagonists and antiarrhythmic drug therapy to mitigate the onset of cardiac arrhythmia. However, the degree of rate and rhythm control achieved is often suboptimal and mortality rates continue to remain high. Implantable cardioverter-defibrillators (ICDs), cardiac resynchronization (CRT), and combined (CRT-D) therapies have emerged as integral and rapidly expanding technologies in the management of select patients with heart failure with reduced ejection fraction (HFrEF). ICDs treat ventricular arrhythmia and are used as primary prophylaxis for sudden cardiac death, while CRT resynchronizes ventricular contraction to improve left ventricular systolic function. Left ventricular assist device therapy has also been shown to provide clinically meaningful survival benefits in patients with advanced HF, and His-bundle pacing has more recently emerged as a safe, viable, and promising pacing modality for patients with CRT indication. Catheter ablation is another important and well-established strategy for managing cardiac arrhythmia in HF, demonstrating superior efficacy when compared with antiarrhythmic drug therapy alone. In this article, we provide a comprehensive and in-depth evaluation of the role of implantable devices and catheter ablation in patients with HFrEF, outlining current applications, recent advances, and future directions in practice.

Heart failure
Catheter ablation
Implantable device
Atrial fibrillation
Ventricular tachycardia
Fig. 1.
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