Iturralde TP

Language: Spanish
References: 9
Page: 86-90
PDF size: 55.01 Kb.

ABSTRACT

Clinical trials have established the superiority of the implantable cardioverter defibrillator (ICD) over antiarrhythmic drug therapy in survivors of sudden cardiac arrest and in high risk patients with coronary artery disease. The ICD has evolved to overcome the limitation of earlier devices that required thoracotomy for implantation and inadequate therapies. At present, it is implanted in a similar manner to cardiac pacemakers and incorporates discrimination algorithms to prevent inappropriate therapy. Managing the patients with an ICD requires an understanding of the multiprogrammable features of modern devices. The cost-effectiveness of ICD therapy appears favorable, given the marked survival benefit seen in randomized trials relative to antiarrhythmic drug treatment. A goal of newer-generation ICD devices is to avoid intervention. Such programmable therapies may include pacing to avoid long short coupling, intermittent antiarrhythmic drug infusion, or multisite pacing to improve hemodynamics. Further advances in device technology will undoubtedly expand the role of the ICD in the primary and secondary prevention of sudden cardiac arrest.

REFERENCES

1. Mirowski M, Reid RR, Mower MM: Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human being. N Engl J Med 1980; 303: 322-324.

2. Iturralde TP: Arritmias cardiacas. México, McGraw-Hill-Interamericana edit. 2a Edición 2002.

3. Buxton AE, Lee KL, Fisher JD, Josephson M, Prystowsky E, Hafley G: A randomized study of the prevention of sudden cardiac death in patients with coronary artery disease. N Engl J Med 1999; 341: 1882-1997.

4. Wilbur SL, Marchlinski FE: Implantable cardioverter-defibrillator Follow-up. Cardiol Rev 1999; 7: 176-190.

5. Pinski SL, Faby GJ: Implantable cardioverter-defibrillators: Am J Med 1999; 106: 446-458.

6. Connolly SJ, Gent M, Roberts RS, Dorian P, Roy D, Sheldon RS, et al: Canadian Implantable Defibrillator Study (CIDS): a randomized study of the implantable cardioverter defibrillator against amiodarone. Circulation 2000; 101: 1297-1302.

7. Kuck KII, Cappato R, Siebels J, Rüppel R: Randomized comparison o antiarrhythmic drug therapy with implantable defibrilator in patients resuscitated from cardiac arrest: the Cardiac Arrest Study Ham burg (CASH). Circulation 2000; 102: 748-754.

8. Wilber D, Kalil J, Kopp D: What can we expect from prophylactic implantable defibrillators. Am J Cardiol 1997; 805(B): 20-27.

9. Rosenquist M, Bayer T, Block M, Den Dulk K, Minten J, Lindemans F: Adverse event with tranvenous implantable cardioverter defibrillators. Circulation 1998; 98: 663-670.