Increasing Sudden Cardiac Death Predictability among Patients for whom Intracardiac Device were Implanted for Different Indications
Abstract
Background: sudden cardiac death (SCD) is defined as death due to any cardiac disease that occurs within one hour after the onset of symptoms. Estimation of the prevalence of QRS prolongation in the population with heart failure (HF) ranges between 20-50%, especially with Coronary Artery Disease (CAD) patients with LVEF< 30%. Intra-ventricular conduction delay (IVCD) or LBBB (but not RBBB) had a 50% increase in the risk of cardiac arrest and total mortality.Aim of study: to test the viability of the following: a cardiac patient who acquires a special clinical triplet is at increasing risk of SCD. , if combined, in a sequence, with IVCD presence).Study design: retrospective study.Patients and methods: 53 consecutive patients, have been studied , for whom ICD. were implanted for various indications from 92000 - 92006 at AL Kadhimiah teaching hospital Males constituted 4153 (77.35%), compared to females 1253 (22.64%) were >46<75 years of age (mean: 60y). All males are > 40<65 years of age. (mean 52ys.)For all these patients who sustained cardiac death & recovered wither spontaneously or through medical intervention & the event responsible for the syncope were well established by continuous ECG monitoring, full history & full clinical examination along with ECG & ECHO study were done. Results: Most common ECG findings were Q waves (either due to MI or DCM),while LBBB IVCD were relatively uncommon Most common Echo findings were ischemic HF (segmental hypokinesiaakinesia)- especially old anterior akinesia. Sub-group I (StHD in males) constituted 35/53,and.Sub-group II (LVS Dysfunction<40%>30%, StHD and male sex) constituted 30/53 Lastly the sub-group III (IVCD, LVS dysfunction, StHD, and male sex) constituted 9/53,Conclusions: *20.45% increment in the probability in predicting SCD in the presence of combined IVCD, LVS dysfunction ( LVEF<40%>30%), StHD, and male sex ; indicating a significant role of the presence of these combined 4 clinical criteria (IVCD, and LVEF<40%>30%, StHD, and male sex) , as potential predictors of SCD.Recommendations: the presence of 4 clinical criteria in a patient is associated with higher probability of SCD. ; neccessating close and watchful surveillance.Key wards: SCD.; Males; St HD.; LVS Dysfunction ; IVCD.
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