Implantable cardioverter-defibrillator
Journal Title: Postępy Nauk Medycznych - Year 2010, Vol 23, Issue 12
Abstract
The first automatic cardiovereter-defibrillator was implanted 30 years ago. Since 1993 transvenous leads have been used. Current devices have improved algorithm for differentiation of arrhythmias. ICD is the main method of treating patients who are at risk of sudden cardiac death. In patients with a prior myocardial infarction and advanced left ventricular dysfunction prophylactic implantation of ICD improves survival. New methods of prediction of sudden cardiac death are needed to identity a group at the highest risk.The main clinical problems associated with ICD are electrical storm, inappropriate interventions, short lifetime of leads, necessity of leads removing, frequent device replacement, infective complications and anxiety disorders. Patients with electrical storm need hospitalization in CCU and sometimes switching off ICD. Most frequent causes of inappriopriate interventions are supraventricular tachyarrhythmias, oversensing and lead damage. Unnecessary defibrillations may cause serious arrhythmias, are stressful for patients and evoke anxiety. Defibrillating lead failure occurs relatively often, causing necessity of removing lead or implantation a new one beside an old. Inactive leads enhance a risk of infection and vein thrombosis. Removing of leads in specialized centers is a safe procedure. Infective endocarditis associated with ICD is an indication for removing ICD with leads. Because of growing number of patients with ICD follow-up is one of the main problem in all centers. Remote home monitoring using phone net for data transmission may be a resolution of this problem This method of follow-up is safe and allows more rapid detection of actionable events compared with conventional monitoring. Remote monitoring is not acknowledged as a procedure in Poland and is not refunded.
Authors and Affiliations
Ewa Makowska
Keywords
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