Sudden cardiac death implantable cardioverter defibrillator

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. 

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

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 for Secondary Prevention of Sudden Cardiac Death... 

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. 

Patients with hypertrophic cardiomyopathy (HCM) who are at high risk for sudden cardiac death should receive an implantable cardioverter-defibrillator (ICD). 

FIGURE 18-4. Treatment algorithm for hypertrophic cardiomyopathy. ACEI = angiotensin-converting enzyme inhibitor NSVT = nonsustained ventricular tachycardia ICD = implantable cardioverter-defibrillator LV = left ventricular SCD = sudden cardiac death. 

Bardy GH, Lee KL, Mark DB, et al. Amiodarone or an Implantable Cardioverter-Defibrillator for Congestive Heart Failure. Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators. N Engl J Med 2005 352(3) 225—37. 

CAD, coronary artery disease ICD, implantable cardioverter defibrillators MI, myocardial infarction Pts, patients SD, sudden death VF, ventricular fibrillation VT, ventricular tachycardia Yr, year EF, ejection fraction EP, electrophysiology SCD, sudden cardiac death. 

Even more severe than the diseases leading to cardiac pacemaker implantation is the sudden cardiac death (SCO). It is the most often reason for death in western industrial countries and accounts for 1200 deaths per day in the USA. SCD is caused by ventricular tachycardia or fibrillation and death occurs within minutes. The only possibility to overcome the tachycardia and to induce a regular heart beat is to delibrillate the heart. In these cases, instead of a normal cardiac pacemaker, a different implant has to be applied. Implantable cardioverter-defibrillators (ICD) have been developed in the 1980s and more than 25 000 devices have been implanted worldwide up to the mid... 

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