The following are key points to remember from this state-of-the-art review on device therapy in chronic heart failure (HF):

1. Innovation in device-based therapies has seen a major change in the last decade.
2. Several device-based therapies have been recently approved for HF and increasingly play an integral role in the management of different phenotypes of HF.
3. Furthermore, the Breakthrough Devices Program has expedited patient access to device-based HF therapies.
4. Currently approved and novel device therapies that are in the pipeline generally allow targeting of a structural or neurohormonal abnormality that is not directly amendable to pharmacologic therapeutic interventions.
5. In patients with a left ventricular ejection fraction (LVEF) of 20%-50%, moderate to severe or severe functional mitral regurgitation, an LV end-systolic diameter of ≤7 cm, and New York Heart Association (NYHA) functional class II-IV despite maximally tolerated guideline-directed medical therapy (GDMT) and cardiac resynchronization therapy (CRT) if appropriate, MitraClip implantation may be considered.
6. In patients with an LVEF of 25%-45%, QRS duration <130 ms, and NYHA functional class III-IV despite maximally tolerated GDMT, cardiac contractility modulation therapy may be considered.
7. In patients with an LVEF ≤35% and NYHA functional class II-III despite maximally tolerated GDMT, baroreflex activation therapy may be considered.
8. In patients with moderate to severe central sleep apnea regardless of LVEF, phrenic nerve stimulation may be considered.
9. Of note, devices do not replace pharmacologic therapies but rather complement them or fill gaps in areas without any proven medical therapies, such as HF with preserved EF (HFpEF). Thus, device-based therapies for HF should be considered complementary to pharmacologic therapy.
10. Finally, additional evidence is needed to support approval of evolving device therapies for patients with HF.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Prevention, Valvular Heart Disease, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Sleep Apnea, Mitral Regurgitation

Keywords: Arrhythmias, Cardiac, Baroreflex, Cardiac Resynchronization Therapy, Device Approval, Heart Failure, Heart Valve Diseases, Mitral Valve Insufficiency, Phrenic Nerve, Secondary Prevention, Sleep Apnea, Central, Stroke Volume, Ventricular Function, Left

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