To downgrade, or not to downgrade: that is the question

I have read with great interest the review paper entitled ‘Cardiac resynchronization therapy (CRT) device replacement considerations: upgrade or downgrade? A complex decision in the current clinical setting’ by Nakouet al. in the latest issue of the journal.1 They nicely summarized and commented on device selection at the time of replacement, considering patient ’s history, demographics, clinical characteristics, and currently available scientific knowledge. Some important issues, however, should be mentioned; (i) Super response to cardiac resynchronization therapy (CRT) seems as a remission process, not a cure. Clinical and echocardiographic parameters h ave worsened when the CRT pacemaker was deactivated at the mid-term follow-up. Furthermore, hospitalizations for heart failure and appropriate device therapies have increased with deactivation.2 (ii) It is important to note that not all defibrillator therapies are related to sudden cardiac death. Conventionally programmed devices can cause inappropriate and unnecessary therapies not related to sudden death, which can be easily prevented using appropriate device programming with higher counting and detection levels while still providing appropriate interventions.3 (iii) Current electroanatomic invasive and non-invasive mapping and ablation technologies with the aid of advanced imaging tools give us the opportunity to map and ablate all abnormal myocardium, which can be the cause of the current and future ventricular arr...
Source: Europace - Category: Cardiology Source Type: research