Heart failure and chronic kidney disease are common and clinically important conditions that regularly coexist. Electrophysiologic changes of advanced heart failure often result in abnormal conduction, causing dyssynchronous contraction, and development of ventricular arrhythmias, which can lead to sudden cardiac arrest. In the last 2 decades, implantable cardioverter-defibrillator and cardiac resynchronization therapy devices have been developed to address these complications. However, when the coexisting chronic kidney disease is advanced, the associated pathophysiologic cardiovascular changes can alter the efficacy and safety of those interventions and complicate the management. This review explores the impact of comorbid advanced heart failure and advanced chronic kidney disease on the efficacy and safety of implantable cardioverter-defibrillator and cardiac resynchronization therapy, the currently available evidence, and potential future directions.

Editors
Editor-in-Chief
Harlan M. Krumholz, MD, SM, FACC 

CME Editor
Ragavendra R. Baliga, MD

Author
Kelvin N.V. Bush, MD, FACC

Important Dates
Date of Release: September 23, 2024
Term of Approval/Date of CME/MOC Expiration: September 22, 2025