Treatment
Chronic Medical Management
Î The percutaneous lead should be secured to reduce traction and infection
because driveline trauma is the primary cause of driveline infections.
Î A strict aseptic protocol should be followed when dressing is changed.
Î Patients should receive physical and occupational therapy while
hospitalized and referral for cardiac rehabilitation at hospital discharge.
Î Treatment with evidence-based heart failure medical therapies could be
beneficial in patients on MCS.
Î Evidence-based management of comorbid conditions (e.g., hypertension,
hyperlipidemia, and diabetes mellitus) is recommended.
Table 6. Equipment to Be Transported With Patient
Implanting center information
Backup controller
Backup batteries
AC power source
Battery charger
Well-Being and End of Life
Î If psychiatric disability is present after MCS, referral to mental health
providers for care, including medication management, counseling, or
cognitive behavioral therapy, is recommended.
Î Palliative care involvement is indicated during MCS evaluation and for
patients with MCS, especially when receiving destination therapy.
Î When the prognosis is poor for patients with MCS and their suffering and
burden outweigh the benefits, deactivation of the MCS device should be
discussed with the patient and family caregivers.
