Cardioverter-defibrillator

Ventricular fibrillation should be terminated by electrical defibrillation. Alternatively, lidocaine can be injected intravenously. In cases with lower frequency, ventricular tachyarrhythmia class I diugs such as aj marine, flecainide or propafenone are more effective as a result of the use-dependence of lidocaine. For prophylaxis treatment, amiodarone or sotalol may be helpful or the implantation of a cardioverter-defibrillator system. Acute amiodarone (i.v. in higher doses) can also terminate ventricular tachyarrhythmias. This action, however, seems to be mediated by its INa-blocking side effects and not (or less) by its class III like effects. 

Larsen GC, Manolis AS, Sonnenberg FA, et al. Cost-effectiveness of the implantable cardioverter-defibrillator effect of improved battery life and comparison with amiodarone therapy. J Am Coll Cardiol 1992 19 1323-34. 

Implantable cardioverter-defibrillators are more effective than antiarrhythmic drugs for reduction in the risk of sudden cardiac death due to VT or VF. 

In patients who have experienced VT and are at risk for sudden cardiac death, implantation of an implantable cardioverter-defibrillator (ICD) is the treatment of choice.44 An ICD is a device that provides internal electrical cardioversion of VT or defibril -lation of VF the ICD does not prevent the patient from developing the arrhythmia, but it reduces the risk that the patient will die of sudden cardiac death as a result of the arrhythmia. Whereas in the past ICD implantation required a thoracotomy, these devices now may be implanted transvenously, similarly to pacemakers, markedly reducing the complication rate. 

GFR Glomerular filtration rate ICD Implantable cardioverter defibrillator... 

Implantable cardioverter-defibrillator (ICD) A device implanted into the heart transvenously with a generator implanted subcutaneously in the pectoral area that provides internal electrical cardioversion of ventricular tachycardia or defibriUation of ventricular fibrillation. 

The use of antiarrhythmic drugs in the United States is declining because of major trials that showed increased mortality with their use in several clinical situations, the realization of proarrhythmia as a significant side effect, and the advancing technology of nondrug therapies such as ablation and the implantable cardioverter-defibrillator (ICD). 

Arcing A cardioverter/defibrillator should not be discharged through a paddle electrode that overlies a transdermal nitroglycerin system. 

Abstract Two thirds of the nearly half a million deaths per year in the United States due to sudden cardiac death (SCD) is attributed to coronary artery disease (CAD) and most commonly results from untreated ventricular tachyarrhythmias. Patients with ischemic cardiomyopathy and left ventricular dysfunction are at highest risk for SCD, but this still defines only a small subset of patients who will suffer SCD. Multiple lines of evidence now support the superiority of implantable cardioverter defibrillator (ICD) therapy over antiarrhythmic therapy for both primary and secondary prevention of SCD in advanced ischemic heart disease. Optimization of ICD therapy in advanced ischemic cardiomyopathy includes preventing right ventricular pacing as well as the use of highly effective anti-tachycardia pacing to reduce the number of shocks. While expensive, ICD therapy has been shown to compare favorably to the accepted standard of hemodialysis in cost effectiveness analyses. 

Implantable cardioverter defibrillators, on the other hand, have demonstrated a remarkable effectiveness in prevention of SCD, with an overall 1-year survival rate of 92% in patients with documented life-threatening ventricular tachyarrhythmias [26]. Three randomized, controlled trials have demonstrated the ICD to be superior to antiarrhythmic medications in the secondary prevention of SCD [27-29]. Recent primary prevention studies have also demonstrated improved... 

Implantable Cardioverter Defibrillators for Secondary Prevention of Sudden Cardiac Death... 

Prevention of Harm in Patients with Implantable Cardioverter Defibrillators... 

Implantable cardioverter defibrillator implantations have increased dramatically over the last decade [45], with a 24% worldwide annual increase in ICD implantations between 1998 and 2002 [1]. There was an increase in the number of Medicare beneficiaries eligible for ICDs by two- to threefold, to more than 500,000, based on the most recent reimbursement criteria [46]. 

Implantable cardioverter defibrillator implantation is expensive, with an estimated cost of 30,000- 50,000 per implant, not including the cost of follow-up. However, economic analysis of ICD studies has shown that ICD implantation compares favorably with such commonly accepted therapies as dialysis for end-stage renal failure [47]. It is estimated that the cost effectiveness ratio for ICDs is 27,000 per life year saved, comparable to those for other well-... 

Seidl K, Senges J. Worldwide utilization of implantable cardioverter/defibrillators now and in the future. Card Electrophysiol itev.Jan 2003 7(1) 5-13. 

Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. NEnglJMed. Jan 20 2005 352(3) 225-237. 

Winkle RA, Mead RH, Ruder MA, et al. Longterm outcome with the automatic implantable cardioverter-defibrillator. J Am Coll Cardiol. May 1989 13(6) 1353-1361. 

Connolly SJ, Gent M, Roberts RS, et al. Canadian implantable defibrillator study (CIDS) a randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation. Mar 21 2000 101(11) 1297-1302. 

Ezekowitz JA, Armstrong PW, McAlister FA. Implantable cardioverter defibrillators in primary and secondary prevention a systematic review of randomized, controlled trials. Ann Intern Med. Mar 18 2003 138(6) 445-452. 

Hohnloser SH, Kuck KH, Dorian P, et al. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med. Dec 9 2004 351(24) 2481-2488. 

Anvari A, Stix G, Grabenwoger M, et al. Comparison of three cardioverter defibrillator implantation techniques initial results with transvenous pectoral implantation. Pacing Clin Electrophysiol. Jul 1996 19(7) 1061-1069. 

Cardinal DS, Connelly DT, Steinhaus DM, et al. Cost savings with nonthoracotomy implantable cardioverter-defibrillators. AmJCardiol.Oecl 1996 78(11) 1255-1259. 

Godemann E, Butter C, Lampe F, et al. Panic disorders and agoraphobia side effects of treatment with an implantable cardioverter/defibrillator. Clin Cardiol. Jun 2004 27(6) 321-326. 

Fromer M, Brachmann J, Block M, et al. Efficacy of automatic multimodal device thempy for ventricular tachyarrhythmias as delivered by a new implantable pacing cardioverter-defibrillator. Results of a European multicenter study of 102 implants. Circulation. Aug 1992 86(2) 363-374. 

Higgins SL. Impact of the multicenter automatic defibrillator implantation trial on implantable cardioverter defibrillator indication trends. Am J Cardiol. Mar 11 1999 83(5B) 79D-82D. 

Morgan JM. Cost-effectiveness of implantable cardioverter defibrillator therapy. J Cardiovasc Electrophysiol. Jan2002 13(l Suppl) S114- l 17. 

However, the long-term effects of cardiac resynchronization therapy (CRT) on morbidity and mortality were not known. Two clinical trials have established the morbidity and mortality effects of CRT. The COMPANION trial was a three armed trial, testing optimal medical therapy (OPT) against OPT plus CRT by a pacemaker or a OPT plus CRT by an implantable cardioverter-defibrillator (CRT-D) [118]. In this study, patients were enrolled prior to... 

Chachques JC, Herreros J, Trainini J, Juffe A, Rendal E, Prosper F, Genovese J. Autologous human serum for cell culture avoids the implantation of cardioverter-defibrillators in cellular cardiomyoplasty. Int J Cardiol 2004 95 Suppl LS29-33. 

As left ventricular dysfunction is a major predictor of sudden arrhythmic death, cardiac death and total mortality, it can be stated that in general sudden cardiac death prevention is achievable with the combination of an implantable cardioverter defibrillator (ICD) and medical therapy. 

Drug therapy and the use of cardioverter defibrillators will not improve the prognosis of patients in this stage. Cardiac transplantation will be the only option. With the patient s informed consent, even inactivation of an ICD can be considered as a possible option in this stage of the disease. The critical issue is fiuid retention control. To achieve this objective, the administration of intravenous positive inotropic agents cannot be weaned off. As a strategy for palliation, vasodilators are sometimes used even though they may worsen mortality. 

Connolly SJ, Dorian P, Roberts RS, Gent M, Bailin S, Fain ES et al. Comparison of beta-blockers, amiodarone plus beta-blockers, or sotalol for prevention of shocks from implantable cardioverter defibrillators the OPTIC Study a randomized trial. JAMA 2006 295 165-71. 

The first implantable cardioverter-defibrillator (ICD) was placed in 1982. Since that time, their use has expanded exponentially. Several large clinical trials have demonstrated the superiority of ICDs compared with pharmacological therapy for the secondary prevention of arrhythmic death and possibly as primary therapy for patients at risk for ventricular arrhythmias. 

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