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[10 years of therapy with implantable defibrillators--observation in 353 patients]
H J Trappe1, P Wenzlaff, H Klein
1Abteilung Thorax-, Herz- und Gefässchirurgie, Medizinische Hochschule Hannover.
Insights
Implantable cardioverter-defibrillators (ICDs) show high efficacy in treating ventricular tachyarrhythmias. Non-thoracotomy ICD implantation has lower operative mortality compared to epicardial procedures.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Devices
Context:
- The study analyzes data from 353 patients who received implantable cardioverter-defibrillators (ICDs) since 1984.
- It compares outcomes between epicardial and non-thoracotomy ICD implantation procedures.
- Patient follow-up averaged 25 months, assessing mortality and device performance.
Purpose:
- To evaluate the safety and efficacy of implantable cardioverter-defibrillators (ICDs).
- To compare operative mortality between epicardial and non-thoracotomy ICD implantation techniques.
- To assess the incidence of sudden arrhythmic death, cardiac death, and other causes of mortality post-ICD implantation.
Summary:
- Overall operative mortality was 3%, with significantly higher rates for epicardial (5%) versus non-thoracotomy (<1%) ICD implantation.
- During follow-up, 19% of patients died, with sudden arrhythmic death and cardiac death being significant causes.
- Appropriate ICD discharges occurred in 72% of patients, effectively managing ventricular tachyarrhythmias (VTAs) through shocks and antitachycardia pacing.
Impact:
- Non-thoracotomy ICD implantation is associated with lower operative mortality, suggesting a safer surgical approach.
- ICDs demonstrate significant effectiveness in preventing sudden arrhythmic death and managing VTAs.
- The findings support the continued use and refinement of ICD technology for managing life-threatening arrhythmias.
Abstract:
Since January 1984, the cardioverter-defibrillator (ICD) has been implanted in 353 patients (pts). Epicardial ICD implantation was performed in 207 pts and 146 pts underwent non-thoracotomy ICD implant. Overall operative mortality was 3% (12/353 pts) and was significantly higher in pts with epicardial ICD implantation (11/207 pts, 5%) than in patients who received non-thoracotomy ICDs (1/146 pts, < 1%) (p < 0.05). During a mean follow-up of 25 +/- 23 months, 63 pts (19%) died: 8 pts (0.8% per year) from sudden arrhythmic death and 6 pts (0.8% per year) suddenly without an underlying arrhythmia. Cardiac death was observed in 36 pts (4% per year) and 13 pts (2% per year) died from other causes. Appropriate ICD discharges were observed in 245 pts (72%) with a mean incidence of 22 +/- 44 IC discharges per pt. In pts with third-generation ICDs, 3,542 ventricular tachyarrhythmias (VTA) were observed and terminated by primary ICD shocks in 778 VTA (22%). Antitachycardia pacing was attempted in 2,764 VTA (78%) and was successful in 2,484 VTA (90%).