Cardiac interventions

Some cardiac interventions may improve quality of life in heart failure even in advanced disease.

For patients who have an implantable device, it is important to establish whether it is purely a pacemaker or a device which includes defibrillator function.

As part of Advance Care Planning, consider deactivation of ICD. This is discussed in more detail in the Dying Phase later in this chapter.

Cardiac resynchronization therapy (CRT)

Also known as the biventricular pacemaker, may be beneficial in carefully selected patients to correct cardiac ‘dyssynchrony’ (uncoordinated and inefficient pumping of the right and left ventricles).

CRT pacing therapy in advanced cardiac failure can improve:

  • haemodynamics
  • symptoms
  • quality of life

Types of device include:

  • CRT-P (pacing mode)
  • CRT-D (pacing and defibrillator function)

Some ICDs (Implantable Cardioverter Defibrillators) function purely as defibrillators reducing sudden cardiac death in patients with cardiac failure in those surviving a ventricular arrhythmic event (secondary prevention) and for primary prevention.


This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.

Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.

While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.