Chu-Pak Lau


Implantable devices are now used to treat patients with congestive heart failure (CHF) with electromechanical in dyssynchrony.1-4 The proven benefits include improvement in cardiovascular functional state such as better exercise capacity, 6 min-hallwalk distance, New York Heart Association Class and quality of life. There is also measurable structural change in reverse left ventricular (LV) remodelling.5 These lead to combined clinical benefit of reduced hospitalisation and possibly reduced mortality. On the other hand, patients with CHF has a high risk of concomitant arrhythmias, and sudden cardiac death is an important cause of mortality in these patients.6 Prophylactic implantable cardioverter defibrillator (ICD) has been shown to improve survival over best medical therapy when implanted either for primary or secondary prevention.7-8 Thus when a device is prescribed for any patients, one must consider these therapeutic options so that the patient can derive the maximum benefit from an optional device. Upgrading a device is not only costly, but can be difficult because of access issues and complexity of multiple leads.