medigraphic.com

2002, Number 3

<< Back Next >>

Arch Cardiol Mex 2002; 72 (3)

Follow-up of a group of patients with automatic implantable defibrillator

Mendoza GC, Iturralde T, Guevara VME, Medeiros DA, Rodríguez CL, Rodríguez BI, Colin LL

Language: Spanish
References: 22
Page: 220-226
PDF size: 142.17 Kb.


ABSTRACT

The automatic implantable defibrillator (AID) is the treatment of choice for primary and secondary prevention of sudden death. At the Instituto Nacional de Cardiología, since October 1996 until January 2002, 25 patients were implanted with 26 AID. There were 23 men (92%) and the mean age of the whole group, was 51.4 years. Twenty-three patients (92%) presented structural heart disease, the most common was ischemic heart disease in 13 patients (52%), with a mean ejection fraction of 37.8%. One patient without structural heart disease had Brugada Syndrome. The most frequent clinical arrhythmia was ventricular tachycardia in 14 patients (56%). The mean follow-up was of 29.3 months during which a total of 30 events of ventricular arrhythmia were treated through AID; six of them were inappropriate due to paroxismal atrial fibrillation; 10 AID patients (34%) have not applied for therapy. Three patients (12%) of the group died due to congestive heart failure refractory to pharmacologic treatment. Conclusion: The implant of the AID is a safe and effective measure for primary and secondary prevention of sudden death. Worldwide experience evidences, that this kind of device has not modified the mortality rate due to heart failure in these patients, but it has diminished sudden arrhythmic death.


REFERENCES

  1. Cappucci A, Boriani G: Drugs, surgery, cardioverter-defibrillator: a decision based on the clinical problem. Pacing Clin Electrophysiol 1993; 6: 519-526.

  2. Gillum RF: Sudden coronary death in the United States. Circulation 1989; 9: 756-765.

  3. Mirowski M, Reid PR, Moer MM: Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med 1980; 303: 322-324.

  4. Akhtar M, Jazayeri M, Sra J, Tchou P, Rovang K, Blanck Z, et al: Implantable cardioverter defibrillator for prevention of sudden cardiac death in patients with VT and ventricular fibrillation. Pacing Clin Electrophysiol 1993; 6: 511-518.

  5. Trappe HJ: The modern implantable cardioverter-defibrillator: comparing it to those of the late 1980s. Am J Cardiol 1996; 8(Suppl 5): 3-8.

  6. Connolly SJ, Yusuf S: Evaluation of the implantable cardioverter-defibrillator in survivors of cardiac arrest: the need for randomized trials. Am J Cardiol 1992; 69: 959-962.

  7. Myerburg RJ, Kessler KM, Castellanos A: Sudden cardiac death: structure function, and time-dependence of risk. Circulation 1992; 85(Suppl I): I-2-I-10.

  8. Wilber DJ, Kopp D, Olshansky B: Nonsustained ventricular tachycardia and other high-risk predictors following myocardial infarction: implications for prophylactic automatic implantable cardioverter-defibrillator use. Prog Cardiovasc Dis 1993; 36: 179-194.

  9. The antyarrhythmics versus implantable defibrillators (AVID) investigators: a comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near fatal ventricular arrhythmias. N Engl J Med 1997; 337: 1576-1583.

  10. Siebels J, Cappato R, Ruppel R: Preliminary results of the cardiac arrest study Hamburg. Am J Cardiol 1993; 72: 109F-113F.

  11. Moss AJ, Hall WJ, Cannom DS: Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. N Engl J Med 1996; 335: 1933-1940.

  12. Buxton A, Lee K, Fisher J, Josephson M, Prystowsky E, Hafley G: The multicenter unsustained tachycardia trial investigators. A randomized study of the prevention of sudden death in patients with coronary artery disease. N Engl J Med 1999; 341: 1882-1890.

  13. Buxton A, Lee K, Fisher J, Josephson M, Prystowsky E, Hafley G: The multicenter unsustained tachycardia trial investigators. Electrophysiologic testing to identify patients with coronary artery disease who are at risk for sudden death. N Engl J Med 2000; 342: 1937-1945.

  14. Link MS, Costeas XF, Griffith JL: High incidence of appropriate implantable cardioverter-defibrillator therapy in patients with syncope of unknown etiology and inducible ventricular arrhythmias. J Am Coll Cardiol 1997; 29: 370-375.

  15. Strickberger SA, Man KC, Daoud EG: A prospective evaluation of catheter ablation of ventricular tachycardia as adjuvant therapy in patients with coronary artery disease an implantable cardioverter-defibrillator. Circulation 1997; 96: 1525-1531.

  16. Natale A, Sra J, Axtell K: Ventricular fibrillation and polymorphic ventricular tachycardia with critical coronary artery stenosis: does bypass surgery suffice? J Cardiovasc Electrophysiol 1994; 5: 988-994.

  17. Saxon LA, Wiener I, DeLurgio DB: Implantable defibrillators for high risk patients with heart failure who are awaiting cardiac transplantation. Am Heart J 1995; 130: 501-506.

  18. Brugada P, Brugada J: Right bundle block, persistent ST segment elevation and sudden cardiac death: a distinct clinical and electrocardiographic syndrome. A multicenter report. J Am Coll Cardiol 1992; 20: 1391-1396.

  19. Kakishita M, Kurita T, Matsuo K, Taguchi A, Suyama K, Shimizu W, et al: Mode of onset of ventricular fibrillation in patients with Brugada Syndrome detected by implantable cardioverter defibrillator therapy. J Am Coll Cardiol 2000; 36: 1646-1653.

  20. Brugada J, Brugada R, Brugada P: Right bundle-branch block and ST segment elevation in leads V1 through V3 a marker for sudden death in patients without demonstrable structural heart disease. Circulation 1998; 97: 457-460.

  21. Schaumann A: Managing atrial tachyarrhythmias in patients with implantable cardioverter defibrillators. Am J Cardiol 1999; 83: 214D-217D.

  22. Gollob MH, Serger JJ: Current status of the implantable cardioverter-defibrillator. Chest 2001; 119: 1210-1221.




2020     |     www.medigraphic.com