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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Single-chamber versus dual-chamber implantable cardioverter defibrillators: indications and clinical results
H J Trappe1, M Achtelik, P Pfitzner
1Department of Cardiology and Angiology, University Hospital Herne, Ruhr-University Bochum, Germany.
Insights
Implantable cardioverter defibrillator (ICD) therapy effectively prevents sudden cardiac death in elderly patients and those with severe heart failure. Dual-chamber ICDs show promise for improving heart failure symptoms and aiding diagnosis.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- The clinical efficacy of standard implantable cardioverter defibrillator (ICD) therapy in elderly patients or those with moderate-to-severe heart failure experiencing ventricular tachyarrhythmias remains a subject of debate.
- Assessing patient outcomes based on functional heart failure status and age is crucial for refining treatment strategies.
Purpose of the Study:
- To evaluate the clinical benefit and survival outcomes of standard ICD therapy in a cohort of patients stratified by age and heart failure severity.
- To explore the preliminary efficacy and diagnostic utility of dual-chamber ICDs in managing heart failure and preventing inappropriate therapies.
Main Methods:
- A retrospective analysis of 450 patients who underwent standard ICD implantation, examining follow-up data in relation to New York Heart Association (NYHA) class and patient age.
- A preliminary evaluation of 15 patients who received dual-chamber ICDs, assessing changes in heart failure status and the diagnostic capabilities of the devices.
Main Results:
- ICD therapy demonstrated a significant ability to prevent sudden cardiac death in patients with severely depressed left ventricular function and in those aged 65 years or older.
- During a mean follow-up of 24 months, 23% of patients died, with the majority succumbing to congestive heart failure or myocardial infarction, rather than sudden arrhythmic death.
- In the small cohort of dual-chamber ICD recipients, 33% showed improvement in heart failure symptoms, with no patients experiencing worsening of their condition. Dual-chamber sensing and waveform storage proved valuable for managing ICD therapies.
Conclusions:
- Standard ICD therapy is effective in preventing sudden cardiac death in high-risk patient groups, including the elderly and those with advanced heart failure.
- Dual-chamber ICDs offer potential hemodynamic benefits and improved diagnostic capabilities, representing a promising advancement for individualized patient management and the reduction of inappropriate shocks.
Abstract:
The clinical benefit of standard (single-chamber) implantable cardioverter defibrillator (ICD) therapy in elderly patients or in subjects with moderate or severe heart failure who had ventricular tachyarrhythmias has been debated. We studied the follow-up of 450 patients who underwent standard ICD implantation at our institution in relation to the functional status of heart failure (New York Heart Association Class) or patient's age. During a mean follow-up of 24 +/- 28 months (range, < 1-114 months), 90 patients (23%) died: 9 patients (2%) from sudden arrhythmic death and 5 patients (1%) suddenly, but probably not from arrhythmic causes; 55 patients (14%) died from congestive heart failure and/or myocardial reinfarction and 21 patients (5%) from noncardiac causes. We could clearly demonstrate that ICD therapy was able to prevent sudden cardiac death, both in patients with severely depressed left ventricular function and in patients aged > or = 65 years. An important step forward in ICD technology was the introduction of dual-chamber pacing possibilities to improve left ventricular dysfunction and to allow a more individualized ICD therapy. At our institution, we have implanted a dual-chamber ICD in 15 patients. Preliminary results showed that heart failure improved in 5 patients (33%) and remained unchanged in 10 patients (67%, p = not significant). There were no patients who had a lesser degree of heart failure after implant. Based on our experience so far, in addition to the hemodynamic benefits of dual-chamber ICDs, dual-chamber sensing and wave-form storage capabilities are very helpful and promising diagnostic tools for the detection and handling of inappropriate ICD therapies.
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