Therapy of Congestive Heart Failure

Meanwhile, the therapy of congestive heart failure (CHF) with implantable devices has become an established therapy. Beside cardiac resynchronization therapy (CRT), which has been shown to improve hemodynamics and reduce cardiac morbidity and mortality, additional innovative concepts may complete the variety of options in the treatment of heart failure. For highly symptomatic CHF-patients with decreased systolic left ventricular function and a QRS-duration of > 120 ms, CRT is the established therapy. Even in mildly symptomatic patients with reduced left ventricular function and a QRS-duration > 150 ms CRT has been generally recommended to reduce disease progression and cardiac morbidity. The question whether a CRT-ICD or a CRT-pacemaker should be implanted remains still largely unresolved and a decision should be made by an individual approach. For patients with systolic CHF in sinus rhythm and QRS-duration < 120 ms and for non-responders after CRT-implantation cardiac contractility modulation (CCM) may be a promising innovative and alternative approach for CHF-therapy. CCM increases the intracellular calcium concentration and thus the ventricular myocardial contractility by myocardial stimulation in the refractory period. For CHF-patients with central sleep apnea the transvenous stimulation of the phrenic nerve with a "diaphragmatic pacemaker" may be another innovative and additional approach. Finally, both device-driven baroreflex-modulation and stimulation of the vagus nerve are novel and promising approaches for future therapy of CHF.