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[Treatment of ventricular tachyarrhythmias with an implantable cardioverter-defibrillator system]
K Frohner1, W Kaltenbrunner, G Laufer
13. Medizinische Abteilung, Ludwig Boltzmann-Institut für Arrhythmieforschung, Wilhelminenspital, Wien.
Insights
The automatic implantable cardioverter defibrillator (AICD) effectively treats drug-refractory ventricular arrhythmias in select patients. Device improvements are needed to enhance antiarrhythmic strategies and patient outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Context:
- Drug-refractory ventricular tachycardia and ventricular fibrillation pose significant risks.
- The automatic implantable cardioverter defibrillator (AICD) is a therapeutic option for life-threatening arrhythmias.
- Patient selection is crucial for AICD implantation.
Purpose:
- To evaluate the efficacy and safety of the AICD in patients with severe ventricular tachyarrhythmias.
- To assess the characteristics of AICD discharges and patient-reported symptoms.
- To identify areas for device improvement in antiarrhythmic therapy.
Summary:
- Five patients with drug-refractory ventricular arrhythmias received AICDs.
- Over a 15.2-month follow-up, 117 shocks were delivered; 45% occurred without symptoms.
- No sudden cardiac deaths occurred; one patient died from heart failure, another from septic shock.
Impact:
- The AICD is an effective treatment for selected patients with life-threatening ventricular tachyarrhythmias.
- Further device modifications, including programmability and pacing options, are necessary to optimize antiarrhythmic strategies.
- This study highlights the need for advanced features in implantable cardioverter-defibrillators for improved patient management.
Abstract:
5 patients (3 with coronary artery disease and chronic myocardial infarction, 2 with dilatative cardiomyopathy) with a mean age of 59 years (range 54-69 years) with drug refractory ventricular tachycardia and/or ventricular fibrillation received the automatic implantable cardioverter defibrillator (AICD). Intraoperative testing revealed a mean defibrillation threshold of 13 +/- 2.7 Joule. Over a mean follow-up period of 15.2 months (range 3-25 months) the patients received a total of 117 discharges. 15% of the delivered shocks were recorded during continuous ECG monitoring, 13% were associated with palpitations and 27% were discharged during syncope. 45% of shocks occurred in the absence of symptoms. No patient died suddenly. 1 patient died of intractable heart failure, 1 patient died of septic shock. In carefully selected patients the automatic implantable cardioverter defibrillator is an effective tool in the treatment of life-threatening ventricular tachyarrhythmias. Modifications of the device to incorporate programmability of the cut-off rate, the sensing criteria and the levels of shock energy, as well as the options for different pacing modes combined with memory functions are needed to improve antiarrhythmic strategies.