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Management of malignant ventricular arrhythmias using antitachycardia devices
R J McCowan1, R Sampath, K C Lee
1Department of Cardiovascular Surgery, Charleston Area Medical Center.
Insights
Implantable cardioverter defibrillators effectively manage cardiac arrest and ventricular tachycardia. These devices showed a low complication rate and were associated with a single death from heart failure during follow-up.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Malignant ventricular arrhythmias, including sustained monomorphic ventricular tachycardia and cardiac arrest, pose significant risks.
- Antitachycardia devices, such as implantable cardioverter defibrillators (ICDs), offer improved treatment options for these life-threatening conditions.
- These devices are increasingly utilized as a primary therapeutic strategy for patients with malignant ventricular arrhythmias.
Purpose of the Study:
- To evaluate the safety and efficacy of implantable cardioverter defibrillators (ICDs) in patients experiencing cardiac arrest or drug-refractory sustained ventricular tachycardia.
- To assess the operative complications and long-term outcomes, including device discharges and mortality, following ICD implantation.
Main Methods:
- A cohort of 26 patients underwent ICD implantation at Charleston Area Medical Center.
- Procedures involved various surgical approaches and concomitant surgical interventions.
- Patient outcomes were monitored during a follow-up period of 9.3 ± 5 months.
Main Results:
- No operative deaths were recorded.
- The sole operative complication was a superficial wound infection.
- During follow-up, 46% of patients experienced defibrillator discharge, and one death (3%) occurred due to heart failure.
Conclusions:
- Implantable cardioverter defibrillators (ICDs) are a safe and effective treatment for malignant ventricular arrhythmias, including cardiac arrest and sustained ventricular tachycardia.
- The implantation procedure demonstrated a low complication rate.
- ICDs provide a crucial therapeutic option, with significant patient benefit observed during the follow-up period.
Abstract:
Cardioverter defibrillators were implanted in 26 patients at Charleston Area Medical Center for management of cardiac arrest (7 patients), and drug refractory sustained ventricular tachycardia (19 patients). A variety of operative approaches and concomitant surgical procedures were utilized in the implantation of these devices. No operative deaths occurred. A superficial wound infection was the only operative complication. During the follow-up period (9.3 +/- 5 months), 11 of 26 patients (46 percent) had a defibrillator discharge and one death occurred (3 percent), which was due to heart failure. Patients with malignant ventricular arrhythmias may present with sustained monomorphic ventricular tachycardia with associated syncope, pre-syncope or without any associated symptoms. Unfortunately, cardiac arrest may be the initial presentation. The use of antitachycardia devices such as implantable cardioverter defibrillators and antitachycardia pacemakers has allowed physicians to more successfully treat patients with malignant ventricular arrhythmias. In a significant number of patients with these arrhythmias, such devices are now used as first-line therapy.