FDA Expands Indication for CRT to Treat Heart Failure
April 22, 2014 — The U.S. Food and Drug Administration (FDA) approved an application from Medtronic for revised labeling for two cardiac resynchronization pacemakers (CRT-P) and eight cardiac resynchronization defibrillators (CRT-D), expanding the indication for use to patients with atrioventricular (AV) block and less severe heart failure.
About 5.1 million people in the United States have heart failure, a condition in which the heart cannot pump enough blood to meet the body's needs. With proper treatment and lifestyle changes, people with heart failure can live longer and more productive lives.
The CRT-P and CRT-D devices (see complete device list below) work by providing electrical impulses to the right and left sides of the heart through implanted leads to the heart’s right ventricle (RV) and left ventricle (LV). The timing of the impulses is programmed by a clinician who synchronizes the patient’s heart to improve cardiac function for heart failure patients. The RV leads used with CRT-D devices are also capable of delivering high voltage energy to defibrillate the heart in the event of ventricular arrhythmia.
The FDA previously approved these devices for patients with more severe heart failure as evaluated by their physician using specific criteria. The new approved use includes patients with less severe heart failure, but who are already indicated to receive RV pacing. With the new indication, these patients will be eligible to receive a device that will pace both sides of their heart instead of just the right.
“Medtronic’s cardiac resynchronization therapy pacemakers and defibrillators can delay the occurrence of heart failure-related urgent care visits for people who meet these new criteria,” said Christy Foreman, director of the Office of Device Evaluation in the FDA’s Center for Devices and Radiological Health. “This approval expands the indication of cardiac resynchronization therapy to this additional patient population.”
The expanded approval for the CRT-D and CDT-P devices was based on data from the Block HF clinical study that compared death, heart failure-related urgent care visits and increases in left ventricular end systolic volume index (LVESVI) in study subjects who received either left and right ventricular pacing, or right ventricular pacing alone. LVESVI is a diagnostic measure of cardiac structure and function. A total of 918 subjects participated in the trial, 531 who received a CRT-P device and 227 who received a CRT-D device. The study showed that the cardiac resynchronization therapy provided by CRT-P and CRT-D devices results in a 27 percent reduction in death, heart-failure-related urgent-care visits, and increases in LVESVI compared to right ventricular pacing alone.
The expanded device approvals are for the following devices manufactured by Medtronic:
- Consulta CRT-P
- Consulta CRT-D
- Syncra CRT-P
- Maximo II CRT-D
- Concerto II CRT-D
- Viva XT CRT-D
- Viva S CRT-D
- Protecta CRT-D
- Protecta XT CRT-D
- Brava CRT-D
For more information: www.fda.gov, www.nhlbi.nih.gov