Related Experiment Videos
Clinical experience in patients with implantable cardioverter defibrillators
H Tsuji1, D M Shahian, F J Venditti
1Section of Cardiology, Lahey Clinic Medical Center, Burlington, Massachusetts.
Insights
Implantable cardioverter defibrillators (ICDs) are useful for patients with life-threatening arrhythmias and structural heart disease, offering good long-term success with acceptable complications. This study shows ICDs effectively manage ventricular tachycardia and reduce sudden cardiac death in high-risk patients.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Patients with life-threatening arrhythmias often have underlying structural heart disease.
- Conventional antiarrhythmic drug therapy can be associated with drug failures and limited efficacy.
- Implantable cardioverter defibrillators (ICDs) are an option for managing patients at high risk of sudden cardiac death.
Purpose of the Study:
- To evaluate the safety and efficacy of implantable cardioverter defibrillators (ICDs) in patients with life-threatening ventricular arrhythmias and structural heart disease.
- To assess the perioperative and follow-up complication rates associated with ICD implantation.
- To determine the long-term success rate of ICDs in suppressing ventricular arrhythmias and preventing sudden cardiac death.
Main Methods:
- A cohort of 40 patients with structural heart disease and life-threatening arrhythmias received an ICD.
- Patients underwent electrophysiologic testing to assess inducibility of ventricular tachycardia.
- Follow-up included monitoring for arrhythmias, appropriate/inappropriate ICD shocks, and complications over a median of 5.5 months.
Main Results:
- The majority of patients (93%) had inducible sustained ventricular tachycardia at electrophysiologic testing.
- One perioperative death occurred (2.5%). During follow-up, 2 sudden deaths (5%) and 18 appropriate ICD shocks (45%) were recorded.
- No serious complications occurred during the follow-up period, with 25% of patients requiring antiarrhythmic drugs and 5% experiencing inappropriate shocks.
Conclusions:
- Implantable cardioverter defibrillators (ICDs) are a useful therapeutic option for patients with life-threatening ventricular arrhythmias and structural heart disease.
- ICDs are associated with an acceptable rate of complications and demonstrate good long-term success in this patient population.
- Further consideration of specific issues related to ICD use is warranted, but the device shows significant benefit in managing high-risk arrhythmia patients.
Abstract:
Forty patients (36 men and 4 women) with life-threatening arrhythmia received an implantable cardioverter defibrillator (ICD). Mean age was 63 years (range, 46 to 80 years). All patients had structural heart disease, with coronary artery disease in 32 patients, idiopathic cardiomyopathy in 7 patients, and hypertensive heart disease in 1 patient. Mean left ventricular ejection fraction was 29 +/- 13%. The clinical arrhythmia was out-of-hospital cardiac arrest in 14 patients (35%), symptomatic sustained ventricular tachycardia in 21 patients (53%), and episodes of syncope without documented spontaneous ventricular arrhythmia but ventricular tachycardia that was easily provoked at the time of electrophysiologic testing in 5 patients (13%). Sustained ventricular tachycardia was induced in 37 patients (93%) at basic electrophysiologic testing. The average number of drug failures was 2.9 +/- 1.4 per patient. One patient (2.5%) died perioperatively because of intractable ventricular tachycardia and ventricular fibrillation. During a median follow-up period of 5.5 months (range 2-21 months) 2 sudden deaths occurred. No patient had a serious complication during the follow-up period. Ten patients (25%) received antiarrhythmic drugs to suppress spontaneous ventricular tachycardia. Appropriate shock treatment was received by 18 patients (45%), and inappropriate shock treatment was received by 2 patients (5%). Several issues regarding use of the ICD must be considered, but the device seems to be useful, and it is associated with an acceptable rate of complications and good long-term success at the present time.