Resynchronization: considering device-based cardiac therapy in older adults

Abstract

Cardiac resynchronization therapy (CRT) is a device-based treatment available to select individuals with systolic heart failure (HF), a large proportion of whom are aged 65 and older. As the field of CRT advances, together with shifting demographics and expanded indications for implantation, there is a need for practitioners caring for older adults to understand what is and is not known about the use of CRT specifically in this population. Clinical trials demonstrating benefits for severe and mild HF have uncertain generalizability to older adults. Other studies demonstrate that device-related complications may be more common with CRT than with simpler devices and more common in older adults. CRT clinical trials also may not adequately capture outcomes and concerns specific to older adults, including quality of life and end-of-life care experiences. Informed decision-making by clinicians, policy-makers, and patients will require greater understanding of the use and outcomes of CRT in older persons.

Figure 1

PA chest x-ray of a patient with a CRT-D system. The system components include the pulse generator, a right atrial pacing lead in the right atrial appendage, an ICD lead with its tip in the right ventricular apex and defibrillation coils in the superior vena cava and right ventricle, and a left ventricular pacing lead in a posterolateral branch of the coronary sinus.

Figure 1

PA chest x-ray of a patient with a CRT-D system. The system components include the pulse generator, a right atrial pacing lead in the right atrial appendage, an ICD lead with its tip in the right ventricular apex and defibrillation coils in the superior vena cava and right ventricle, and a left ventricular pacing lead in a posterolateral branch of the coronary sinus.