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1: Am J Cardiol. 2006 Apr 15;97(8):1255-61. Epub
2006 Mar 9. |
Frequency
and causes of implantable cardioverter-defibrillator therapies: is device
therapy proarrhythmic?
Germano JJ, Reynolds M, Essebag V, Josephson ME.
Harvard-Thorndike Electrophysiology Institute, Cardiovascular Division, Beth
Israel Deaconess Medical Center, Boston, Massachusetts.
Implantable cardioverter-defibrillator (ICD) shocks diminish patients' quality
of life, increase health care resource utilization, and may lead to other
adverse sequelae. Better understanding of the factors that lead to ICD
therapies, and better strategies to avoid unnecessary therapies, are needed to
optimize patient outcomes. Data from major randomized clinical trials involving
the use of ICDs and cardiac resynchronization therapy-defibrillator devices were
reviewed to determine control group mortality rates, control group sudden death
rates, and the frequency of appropriate and inappropriate ICD therapies. In all
studies that classified deaths, appropriate ICD therapies outnumbered control
group sudden cardiac deaths by a factor of 2 to 3. Some of these episodes can
be explained by device programming, by the treatment of potentially unsustained
tachycardias, and by errors of episode classification. Another underexplored
possibility is that device therapy is proarrhythmic. Reasons for frequent
therapies and methods to prevent them are discussed, as well as the notion of
device proarrhythmia and the potentially detrimental effects of ICD shocks.
These issues clearly affect the overall benefit of device therapy and have
important implications for patient management and health care delivery.
PMID: 16616037 [PubMed - in process]