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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
The implantable cardioverter defibrillator: Indications and follow-up
Insights
Sudden cardiac death is often caused by ventricular arrhythmias, treatable with implantable cardioverter defibrillators (ICDs). This study reports on ICD implantation outcomes, finding results comparable to major studies.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Sudden cardiac death (SCD) is a significant public health issue, primarily resulting from ventricular arrhythmias.
- The implantable cardioverter defibrillator (ICD) is the established treatment for preventing SCD.
Purpose of the Study:
- To review indications for ICD implantation based on underlying heart conditions.
- To evaluate the short- and long-term outcomes of ICD implantation.
Main Methods:
- A retrospective, descriptive study of 90 patients who received ICDs between January 2003 and December 2014.
- Analysis of patient demographics, underlying heart diseases, ICD types, and procedural/follow-up outcomes.
Main Results:
- Ischemic heart disease was the most frequent underlying condition (37%).
- Primary prevention accounted for 52% of implantations.
- Complications occurred in 10% early and 23% during follow-up, with inappropriate shocks being most common (12%).
- Secondary prevention indication was a predictor of appropriate ICD therapies (p=0.002).
- Ischemic heart disease and secondary prevention were associated with inappropriate shocks.
Conclusions:
- ICD implantation outcomes in this series were comparable to major international studies and registries.
- The study highlights the safety and efficacy of ICDs in managing ventricular arrhythmias and preventing SCD.
- Understanding predictors of appropriate and inappropriate therapies can optimize patient selection and device programming.
Introduction:
Sudden cardiac death (SCD) is a public health problem. In most cases, it is the consequence of ventricular arrhythmias. The only treatment of proven effectiveness is the implantable cardioverter defibrillator (ICD).
Aim:
To describe indications for ICD implantation according to the underlying heart disease and report it's short and long-term results.
Methods:
We report a retrospective and descriptive study involving 90 patients implanted with an ICD in our facility collected between January 2003 and December 2014.
Results:
The average age of our population was 49 ± 15 years (14-76). A male predominance was noted (sex ratio: 6). Ischemic heart disease was the most common underlying heart disease found in 37% of cases. The average left ventricular ejection fraction was 43.5 ± 17.7%. A slight predominance of primary prevention was noted in our series (52%). Single, dual and triple chamber ICD were used in respectively 34%, 36% and 30% of cases. The use of triple chamber ICD was more frequent in cardiomyopathies and ischemic heart disease. Early complications were observed in 9 patients (10%). No deaths directly related to the ICD implantation procedure was observed in our series. The mean follow-up was 39.7 months (3-136). We recorded 14 deaths. The main cause of death was refractory heart failure. During follow-up, 16 patients (18%) received appropriate ICD shocks. The only predictor of appropriate therapies was the indication of ICD for secondary prevention (p=0,002). Twenty one patients (23%) had complications inherent to the implantation of ICD. The main complication was inappropriate shocks found in 11 patients (12%). The main cause of these shocks was supraventricular arrhythmias 68%). Ischemic heart disease (p = 0.001) and secondary prevention (p = 0.048) were significantly associated with the occurrence of inappropriate ICD shocks. The ICD was explanted after varying delays in 4 patients (4.4%).
Conclusion:
The results of our study were comparable to major ICD studies and registries particularly in terms of procedural, late complications and the occurrence of appropriate ICD therapies.
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