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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
An unmet need for implantable cardioverter-defibrillators in New Zealand
Sonya N Burgess1, Scott A Harding, Iain C Melton
1Cardiology Department Wellington Hospital, Wellington, New Zealand.
Insights
A significant portion of sudden cardiac arrest patients had prior indications for an implanted cardioverter-defibrillator (ICD). This highlights an unmet need for ICD therapy in New Zealand.
Area of Science:
- Cardiology
- Electrophysiology
- Public Health
Background:
- Sudden cardiac arrest (SCA) remains a critical public health concern.
- Implanted cardioverter-defibrillators (ICDs) are crucial for preventing sudden cardiac death in high-risk individuals.
Purpose of the Study:
- To determine the proportion of patients experiencing community cardiac arrest who had pre-existing indications for ICD therapy.
- To identify potential gaps in the referral and implantation of ICDs.
Main Methods:
- Retrospective review of medical histories of adult patients with cardiac arrest presenting to a regional ambulance service.
- Classification of patients' ICD indication status by two electrophysiologists.
Main Results:
- Out of 144 patients, 12% (17 patients) had a documented prior indication for an ICD but had not been referred.
- 60% had no pre-existing ICD indication, while 15% had a possible indication requiring further investigation.
- Among those with a documented indication, 8% had no contraindications, 2% were deemed more suitable for alternative therapy, and 15% had contraindications.
Conclusions:
- A notable percentage of sudden cardiac arrest patients in New Zealand had prior indications for ICDs, suggesting an unmet need.
- Improved identification and referral for ICD therapy could potentially reduce mortality from sudden cardiac death.
Aims:
This study examined the prior history of all patients presenting to the regional ambulance service with community cardiac arrest to determine what proportion of these patients had prior indications for implanted cardioverter-defibrillator (ICD) therapy.
Methods And Results:
We reviewed the medical history of all adult patients presenting to our regional ambulance service with cardiac arrest between 1 June 2007 and 31 May 2008 (n= 144). Patients were classified as either not having an ICD indication, having a possible ICD indication, or having an ICD indication by two electrophysiologists. Eighty-seven patients (60%) had no pre-existing indication for an ICD. Twenty-two patients (15%) had a possible indication for an ICD but required further investigation to confirm this. This group consisted of 6 patients (4%) with previously documented left ventricular ejection fraction <35%, but without a measurement in the last 12 months, 14 patients (10%) with heart failure (n= 10) or syncope (n= 4) without appropriate investigations, and 2 patients with an ICD indication but with co-morbidities that required further investigation. Thirty-five patients (24%) had a documented indication for an ICD. In 11 (8%) there was no evidence of a contraindication, in 3 (2%) alternative therapy was judged more appropriate, and in 21 (15%) contraindications to ICD implantation were also present. Addition of the 11 patients with an ICD indication and the 6 patients with a documented indication requiring updated measurement, 17 patients (12%) had a prior documented ICD indication but had not been referred for this therapy.
Conclusions:
Our observation that 12% of sudden cardiac arrest patients had prior indications for an ICD demonstrates that there is an unmet need for ICDs in New Zealand.
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