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[The implantable cardioverter/defibrillator]
K H Kuck1, J Siebels, M Schlüter
1Abteilung für Kardiologie, Universitätskrankenhaus Eppendorf, Hamburg.
Insights
Implantable cardioverter-defibrillators (ICDs) effectively prevent sudden cardiac death by treating ventricular tachyarrhythmias. However, evidence is lacking to show ICDs reduce overall cardiovascular mortality compared to other therapies.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Malignant ventricular tachyarrhythmias remain a significant cause of mortality despite advances in cardiovascular disease treatment.
- Implantable cardioverter-defibrillators (ICDs), introduced in 1980, are a key therapy for preventing sudden cardiac death.
Purpose of the Study:
- To review the current status and therapeutic goals of ICD therapy.
- To assess the efficacy of ICDs in preventing sudden cardiac death and overall cardiovascular mortality.
Main Methods:
- Review of clinical practice and technical advancements in ICDs.
- Analysis of data from clinical investigations on ICD therapy outcomes.
Main Results:
- ICDs have significantly improved, with technical advances enhancing acceptance and efficacy.
- ICD therapy is highly effective in preventing sudden arrhythmic death, with annual mortality < 2% in high-risk patients.
- ICDs do not prevent nonarrhythmic cardiovascular deaths, and evidence for reducing overall cardiovascular mortality is limited.
Conclusions:
- ICDs are crucial for preventing sudden cardiac death in high-risk patients.
- Further controlled studies are needed to determine if ICD therapy reduces overall cardiovascular mortality.
Abstract:
Despite all advances in the diagnosis and therapy of cardiovascular diseases, the mortality from malignant ventricular tachyarrhythmias is still a major health problem. In addition to established therapeutic strategies in the prevention of sudden cardiac death such as antiarrhythmic drug treatment, catheter ablation or antiarrhythmic drug treatment, cardioverter/defibrillator was introduced to clinical practice in 1980. The number of 50,000 overall implants reflects the current clinical status of the therapy with implantable cardioverter/defibrillators. Significant technical improvements in the defibrillator therapy may contribute to an increase in therapy acceptance. These advances include the introduction of nonthoracotomy lead systems, enhanced defibrillation efficacy, full programmable devices providing tiered electrical therapy, improved diagnostic Holter functions and enhanced arrhythmia detection algorithms. The major present goals of defibrillator therapy are detection and termination of malignant ventricular tachyarrhythmias, prevention of sudden cardiac death, reduction in patient's mortality and improvement in quality of life. The efficacy and safety of defibrillator therapy to prevent sudden arrhythmic death has been proven in several large clinical investigations In patients with this device the annual sudden cardiac death mortality is < 2% even in high-risk patient populations. Compared to sudden cardiac death rate there is a much higher rate of overall cardiac mortality because a defibrillator is not able to prevent nonarrhythmic cardiovascular deaths. There is a clinical impression that cardiovascular mortality is lower in patients treated with an implantable cardioverter/defibrillator compared to patients treated with other therapies. However, there are no results from controlled studies providing scientific evidence that defribillator therapy can decrease overall cardiovascular mortality.(ABSTRACT TRUNCATED AT 250 WORDS)