[Clinical assessment and indications for automatic defibrillation]

A variety of therapeutic options including pharmacological treatment, surgical procedures, ablation interventions and electrotherapy are available for the management of patients who are subject to symptomatic ventricular tachyarrhythmias. Patients with documented sustained ventricular tachycardia or ventricular fibrillation are usually controlled by serial electrophysiological studies. About 30 to 60% of these patients respond to antiarrhythmic drugs during serial electrophysiological testing. Patients with severe left-ventricular function respond less frequently than those of well-preserved function. Long-term follow-up studies have demonstrated that, if ventricular tachyarrhythmias can no longer be induced on antiarrhythmic drugs or if inducibility is at least rendered more difficult, the rate of recurrences is low. In contrast, patients with still inducible ventricular tachyarrhythmias may have a poor prognosis and may suffer from frequent recurrences or may even die suddenly. Thus, nonpharmacological strategies such as an implantable cardioverter/defibrillator, transvenous catheter ablation and map-guided antitachycardia surgery have become important alternatives for drug refractory patients. Since the introduction of the implantable cardioverter/defibrillator using a nonthoracotomy approach, the intraoperative and perioperative mortality and morbidity has been significantly reduced. A widespread use of these newer devices required the establishment of guidelines for the appropriate application of this new treatment modality. Surgical, medical and economic considerations make it imperative that defibrillator therapy should be chosen on a basis of careful patient selection. The presenting clinical arrhythmia and its hemodynamic stability, underlying heart disease and left-ventricular ejection fraction should be taken into consideration.(ABSTRACT TRUNCATED AT 250 WORDS)