Related Experiment Videos
Combining antiarrhythmic drugs and implantable devices therapy: benefits and outcome
Insights
Antiarrhythmic drugs (AAD) combined with implantable cardioverter-defibrillators (ICDs) can reduce shocks and improve quality of life. However, careful patient evaluation is crucial due to potential adverse effects and alternative therapies.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Over 50% of patients with implantable cardioverter-defibrillators (ICDs) also receive antiarrhythmic drugs (AADs).
- Combining AADs with ICDs aims to reduce shock frequency, improve quality of life, and manage arrhythmias.
- Conflicting results exist regarding AAD efficacy in reducing ICD shocks, though recent studies show promise.
Purpose of the Study:
- To evaluate the indications and potential adverse effects of combining AADs with ICDs.
- To discuss alternative therapies and the need for individualized patient assessment.
Main Methods:
- Review of existing literature on AAD and ICD combination therapy.
- Analysis of potential benefits, risks, and alternative treatment strategies.
Main Results:
- AADs can reduce ICD shocks, lengthen tachycardia cycle length, and prevent syncope.
- Adverse effects include increased defibrillation/pacing thresholds and potential detection failure.
- Newer ICDs and catheter ablation offer alternative benefits.
Conclusions:
- Concomitant use of AADs and ICDs requires individualized assessment based on arrhythmia characteristics and drug effects.
- Consider factors like arrhythmia frequency, clinical presentation, defibrillation thresholds, and proarrhythmic potential.
- Alternative therapies like advanced ICD features and catheter ablation should be considered.
Abstract:
At least 50% of patients who received an ICD have been treated with antiarrhythmic drugs (AAD). The potential indications for combining antiarrhythmic drugs and ICD are generally the following: reduction of the number of episodes of ventricular tachycardia or ventricular fibrillation and therefore of the number of shocks, improving patient's quality of life and extending the battery life of the ICD, prevention of supraventricular arrhythmias and/or control of their rate, lengthening of the tachycardia cycle length to allow ventricular tachycardia conversion by antitachycardia pacing and reduction of the number of episodes of syncope. Although previous papers reported conflicting results about pharmacologic therapy in reducing the frequency of iCD shocks, some recent randomized prospective studies showed the efficacy of pharmacologic therapy in reducing the frequency of ICD shocks. The use of antiarrhythmic drugs can have also adverse effect: an increase in the defibrillation threshold, an increase in the pacing threshold and an increase in the VT cycle length leading to detection failure. We have also to consider that some advantages derived from antiarrhythmic drugs can be reached by the new devices with atrial sensing and pacing and/or the possibility of atrial defibrillation or by using catheter ablation as adjunctive therapy to ICD. For these reasons, the concomitant use of antiarrhythmic drugs and ICD should be evaluated in each patient in relation to specific clinical and electrophysiologic features including: the frequency, the rate and the clinical presentation of the ventricular arrhythmia, the effect of the selected drug on the defibrillation threshold, the defibrillation threshold at the implant, the effect of the selected drug on the ventricular function and the likelihood of proarrhythmic events.