# Implanteerbare hartapparaten in hartfalen: nieuwe technologieën en implementatie-uitdagingen

*geplaatst 2026-09-08 · Hartfalen · Heart failure reviews · doi 10.1007/s10741-026-10672-w · https://hartvaat.nl/2026/09/01/implanteerbare-hartapparaten-in-hartfalen-nieuwe-technologieen-en-implementatie-/*

Deze overzichtsstudie belicht de huidige en toekomstige rol van cardiale implanteerbare elektronische apparaten (CIEDs) bij patiënten met hartfalen. Er wordt ingegaan op de verschuiving naar biventriculaire pacing en left bundle branch area pacing (LBBAP), de opkomst van draadloze pacemakers en subcutane defibrillatoren, en de potentie van implanteerbare hemodynamische monitoring. Hoewel deze innovaties de kans op lead-gerelateerde complicaties kunnen verkleinen, wordt adoptie nog geremd door beperkt gerandomiseerd bewijs, procedurele complexiteit en ongelijkheid in zorgtoegang. Voor cardiologen betekent dit dat blijvende evaluatie van nieuwe technologieën en strikte richtlijnadherentie essentieel blijven in de dagelijkse HF-praktijk.

## English: Cardiac implantable electronic devices in heart failure: needs, challenges, and real-world implementation.

This narrative review outlines the evolving role of cardiac implantable electronic devices (CIEDs) in heart failure management, highlighting emerging technologies such as left bundle branch area pacing, leadless pacemakers, and subcutaneous defibrillators. While these innovations aim to reduce lead-related complications and enable remote hemodynamic monitoring, their widespread adoption is currently limited by a lack of robust randomized evidence, procedural complexity, and disparities in healthcare access. Clinicians should remain vigilant in evaluating these devices, as guideline adherence and careful patient selection will continue to dictate their optimal integration into heart failure care.

## Abstract (original, from the publication)

Cardiac implantable electronic devices (CIEDs) are integral to heart failure (HF) management, providing therapies for bradyarrhythmias, cardiac resynchronization therapy (CRT), sudden cardiac death (SCD) prevention, and remote monitoring. This review summarizes current and potential future indications, emerging technologies, and challenges in the implementation of CIEDs in HF. Conventional right ventricular pacing in HF patients is increasingly being replaced by biventricular pacing (BVP) and left bundle branch area pacing (LBBAP), while leadless pacing pacemakers have emerged as an alternative to conventional transvenous systems, offering the potential to reduce lead- and device-related complications. As BVP remains the standard approach for CRT, recent data bestow LBBAP as a promising alternative and integration platform. Newer implantable cardioverter-defibrillator technologies, including subcutaneous and extravascular systems, may reduce lead-related complications while maintaining effective arrhythmia termination and recognition. Advances in atrial fibrillation management, implantable hemodynamic monitoring, and novel pacing indications such as atrioventricular recoupling and personalized pacing in HF with preserved ejection fraction are expanding the therapeutic potential of CIEDs. However, the adoption of these innovations is challenged by limited randomized evidence, procedural complexity, and substantial disparities in access and implementation across healthcare systems. Ongoing clinical trials will help define the role of emerging device technologies and monitoring strategies, while efforts to improve guideline adherence, value-based procurement, and equitable access remain essential to maximize the benefits of CIED therapy in patients with HF.

Auteurs: David Žižek, Miha Mrak, Anja Zupan Mežnar, Maja Ivanovski, Tadej Žlahtič, Christopher F Barrientos, Andrew P Ambrosy, Zlatko Fras, Mauro Biffi, Mitja Lainscak

---
Bron: Heart failure reviews, https://doi.org/10.1007/s10741-026-10672-w. Bijgewerkt 2026-09-02T00:57:32Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.