CHRS/CHFS JOINT WORKSHOP: CARDIAC DEVICE THERAPY IN HEART FAILURE PATIENTS: WHEN THERAPY GOES BEYOND THE GUIDELINES (CCC-167)

Saturday, October 28, 2023

09:45 – 10:30 EST

Location: Palais, 518ABC

Target Audience: Clinical cardiologists, Electrophysiologists, Heart failure specialists

Co-Chair(s)

Laurence D. Sterns, BMSc,MD,FRCPC

Cardiac Electrophysiologist
CHRS
Mustafa Toma, FRCPC

Clinical Associate Professor, Medical Director, Heart Transplant/MCS
St. Paul's Hospital
University of British Columbia

Presenter(s)

Jacinthe Boulet (she/her/hers)

Advanced heart failure and transplantation
CHFS
Montreal Heart Institute
Jacqueline Joza, MD MSc

Cardiac electrophysiologist
McGill University Health Centre
McGill University Health Centre
Michael A. McDonald, MD

Cardiologist
CHFS
Toronto General Hospital
Michael Thibert

Cardiac Electrophysiologist
Royal Jubilee Hospital

Planning Committee Member(s)

Justin Ezekowitz, MD

Professor
CHFS
University of Alberta
Laurent Macle, MD, FRCPC, FHRS

Cardiac Electrophysiologist
Institut de Cardiologie de Montréal
Université de Montréal

Disclosure(s):

Laurence D. Sterns, BMSc,MD,FRCPC: No financial relationships to disclose

Mustafa Toma, FRCPC: Bayer: Consultant/Advisory Board (Ongoing), Speaker/Honoraria (Ongoing); BI: Consultant/Advisory Board (Ongoing), Speaker/Honoraria (Ongoing); Novartis: Consultant/Advisory Board (Ongoing), Speaker/Honoraria (Ongoing); Servier: Consultant/Advisory Board (Ongoing), Speaker/Honoraria (Ongoing)

Jacinthe Boulet: No financial relationships to disclose

Jacqueline Joza, MD MSc: Boston Scientific: Consultant/Advisory Board (Ongoing); Medtronic Inc: Research Grant (includes principal investigator, collaborator or consultant and pending grants as well as grants already received) (Ongoing)

Michael A. McDonald, MD: BI-Lilly: Consultant/Advisory Board (Terminated, October 31, 2022); Novartis: Speaker/Honoraria (Terminated, October 1, 2022); Servier: Speaker/Honoraria (Terminated, December 1, 2022)

Michael Thibert: No financial relationships to disclose

Learning Objectives / Objectifs d'apprentissage:

At the end of this session participants will be able to / Au terme de cette conférence, vous serez:

identify patient situations where Cardiac Resynchronization Therapy may be beneficial outside current guidelines, such as moderate LV dysfunction with LBBB and newly diagnosed LV dysfunction;
recognize patients with heart failure who have pacing indications who should be referred for conduction system pacing or Cardiac Resynchronization Therapy;
determine which patients with non-ischemic cardiomyopathy should be referred for primary prevention ICD therapy; and
identify patients with traditional pacing systems who would be candidates for upgrade to conduction system or Cardiac Resynchronization Therapy pacing.

Workshop Description: The indications for cardiac resynchronization therapy in patients with advanced heart failure are usually well understood. However, there is increasing data that the earlier utilization of resynchronization therapy in patients with more moderate congestive heart failure may improve quality of life and prognosis. The newer data supporting this earlier utilization of device therapy has not yet been incorporated into the current guidelines for patient therapy, therefore frequently practitioners are uncertain when to move forward with referrals for these patients.

This workshop will specifically examine different scenarios of patients with congestive heart failure and conduction system disease to see when earlier referral for device therapy may be in the patient's best interest. Through these case-based presentations and discussions we will review the data showing improvement in cardiac function and quality of life with earlier implantation of resynchronization therapy. These cases will highlight clinical situations that could be seen in primary care, internal medicine practices, heart function clinic, or cardiac device clinics. We will review the indications for de novo implantation of CRT pacemakers, indications for upgrading standard devices to resynchronization pacemakers, look at the indications for primary prevention ICD therapy in patients with non-ischemic cardiomyopathy, and finally review the evolving data and clinical places where conduction system pacing may be a reasonable or possible superior alternative.

This workshop has been developed through collaboration of the Canadian Heart Rhythm Society and its education committee, as well as the Canadian Heart Failure Society. The topics to be covered in the session were developed based on an evaluation of referrals from the heart function clinics for device therapy at several Canadian EP centers. These topics were felt to represent the most common areas of uncertainty in the management of these patients, and this workshop aims to directly address those areas of uncertainty to give guidance for the management of these patients. This would be targeting not just subspecialists and heart rhythm and heart failure clinics, but general cardiologists, internal medicine specialist, and primary care physicians who are involved in the management of these patients.