Experience in ICD Implantation and Follow-up in Ibn- Albitar Hospital


ABSTRACT:BACKGROUND:Survivals of sudden cardiac death (SCD) episodes have recurrence rate of 30-50% within two years, with malignant ventricular arrhythmias most often responsible1, 2. The overall survival rate for SCD in USA is 5%. Ninety-five percent of patients suffering their initial event fail to survive to become candidate for secondary prevention1.Because of the wide spread acceptance of implantable cardioverter defibrillator ( ICD ) as a method treating the survivals of SCD, attention has turned to primary prevention 1. Implantable cardioverter-defibrillator (ICD) is highly effective in primary and secondary prevention of SCD due to life threatening ventricular tachycardia (VT).OBJECTIVE:To register and interpret the results of implantation and follow-up of ICD during the period between 2002-2007 in Ibn Al-Bitar hospital.METHODS:Sixty patients with standard indications for ICD; data were pooled from patients history, ECG, Echocardiography, Holter, blood investigation and coronary angiography.75% males and 25% females. After implantation, class III anti-arrhythmic drugs (Amiodarone) were stopped, except for patients with a history of supraventricular tachycardia or recurrent VT.RESULTS:Coronary artery disease (CAD) was the most common presentation of patients for whom implantation was done; coronary artery disease (CAD) 43%, dilated cardiomyopathy (DCM) 26%, and hypertrophic obstructive cardiomyopathy (HOCM) 16%. Sixty-three of them had moderate-severe LV dysfunction (LVEF<40%). Recurrent VT was the most common cause of implantation (76%). Primary prevention was aimed in (60%) of patients and secondary prevention in 40%. Sixty percent of those with ICD implanted due to primary prevention fulfil MADIT II (Multicenter Automatic Defibrillator Implantation Trial II) criteria. The majority of patients had structural heart disease. Most non-sustained VTs reverted to sinus rhythm by antitachycardia pacing (ATP) therapy from ICD (90%).All VF events reverted to sinus rhythm by high energy shock from ICD devices.CONCLUSION:ICD is highly effective in primary and secondary prevention of life threatening VT/VF.