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From the trial to the clinic: The latest evidence on device-led management

Heart Failure 2016 Congress News

Frank Ruschitzka, University Heart Center, University Hospital Zurich, Switzerland

The new ESC Guidelines: Focus on arrhythmias and devices; 23 May, 11:00–12:30; London

The use of devices in heart failure management has come of age in recent years, with the publication of a number of trials that have solidified and further defined their role, a leading expert will say this morning.

Frank Ruschitzka (University Heart Center, University Hospital Zurich, Switzerland), incoming president of the Heart Failure Association, will co-chair a session on the arrhythmias and devices section of the new European Society of Cardiology (ESC) Heart Failure Guidelines with Mariell Jessup (University Of Pennsylvania, Philadelphia, USA).

He told Heart Failure Congress News that the latest update was made necessary by the large number of clinical trials published since the previous version in 2012.

Prof. Ruschitzka said that there are now eight life-saving therapies in heart failure, “and four of them are devices”. This includes implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy (CRT), and left ventricular assist devices (LVADs), alongside heart transplantation.

“So heart failure is not only about drug therapy anymore as it blends drug, device therapy and multi-disciplinary interventions. This is what makes heart failure so particularly innovative and novel,” he said.

The arrhythmias and devices section takes into account both positive and negative trails results. One of the most important trials was led by Prof. Ruschitzka.(1) This showed that CRT does not improve outcomes in patients with systolic heart failure and a QRS duration of less than 130 ms, a finding supported by a subgroup analysis.(2)

For Prof. Ruschitzka, these studies underline that, although CRT is a life-saving therapy, “apparently there’s no such thing as unmitigated good”.

In contrast, the CHAMPION trial,(3) which looked at the CardioMEMS device (St Jude Medical Inc, Atlanta, Georgia, USA), and the IN-TIME study, presented at the ESC Congress 2013, showed that home and remote hemodynamic monitoring translate into clinically meaningful benefits.

Also addressed are novel multidisciplinary interventions, particularly percutaneous valvular interventions, alongside the latest development on LVADs and transplantation.

For a preview of tomorrow’s session on the chronic heart failure section of the new guidelines, see the next issue of Heart Failure Congress News.


  1. Ruschitzka F, Abraham WT, Singh JP et al. Cardiac-resynchronization therapy in heart failure with a narrow QRS complex. N Engl J Med. 2013; 369: 1395-1405.
  2. Steffel J, Robertson M, Singh JP et al. The effect of QRS duration on cardiac resynchronization therapy in patients with a narrow QRS complex: a subgroup analysis of the EchoCRT trial. Eur Heart J. 2015; 36: 1983-1989.
  3. Abraham WT, Adamson PB, Bourge RC et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet. 2011; 377: 658-666.

View the session programme and access the resources on SP&P