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[Automatic implantable defibrillators: long-term results]
1Service de cardiologie, hôpital Lariboisière, Paris.
Insights
The automatic implantable defibrillator (AID) effectively prevents sudden death from malignant ventricular arrhythmias. However, its impact on overall cardiac mortality remains debated, with patient hemodynamics being a key factor.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Context:
- Malignant ventricular arrhythmias pose a risk of sudden cardiac death.
- Automatic implantable defibrillators (AIDs) are used for primary prevention.
- Controversy exists regarding the AID's effect on global cardiac mortality.
Purpose:
- To review the controversy surrounding the efficacy of AIDs in reducing global cardiac mortality.
- To identify prognostic factors influencing AID outcomes.
- To highlight the role of hemodynamic status and left ventricular function.
Summary:
- AID efficacy in preventing sudden death from ventricular arrhythmias is established.
- The impact of AIDs on overall cardiac mortality is debated.
- Patient's hemodynamic status, particularly left ventricular function, is a critical prognostic factor.
Impact:
- Understanding the controversy aids in refining AID indications.
- Objective assessment of left ventricular function is crucial for patient selection.
- Ongoing randomized trials will clarify the role of AIDs in managing cardiac mortality.
Abstract:
The automatic implantable defibrillator is an essential component of the preventive management of sudden death of patients with malignant ventricular arrhythmias. Though its efficacy in this indication is not contested, the data concerning its influence on global cardiac mortality is more controversial. The elements of this controversy are reviewed. Several prognostic factors are implicated, the principal of which being the patient's haemodynamic status as assessed by objective evaluation of left ventricular function. Prospective randomised studies comparing medical therapy with the automatic implantable defibrillator are under way and should provide a better understanding of its indications in the future.