Specific Complications in the Treatment with Implantable Casrdioverter-Defibrillators

Overview

Background.
Using implantable cardioverter-defibrillators in treatment of malignant ventricular arrhythmiasrevealed new complications specific to this therapy. Inappropriate therapy, arrhythmic storm and device relatedproarrhythmia belong to the most significant complications. The authors describe specific complications in a groupof ICD patients, analyze their etiology and prognostic value. There are some recommendations for the managementof specific complications.Methods and Results. 138 consecutive patients underwent ICD implantation between 1994-2001. Median follow-upwas 47,35 months.Average left ventricular ejection fractionwas 38±14%and 71%of patients suffered from coronaryartery disease. From the total of 2490 arrhythmic episodes 1490 were evaluated in detail. 253 episodes (17 %) wereclassified as inappropriate therapy. The most common etiology of inappropriate therapy was atrial fibrillation withrapid ventricular response (68%), atrial flutter (13%) and sinus tachycardia (11%). After the therapeutic intervention,65 % of them remained free of inappropriate therapy. There were 38 arrhythmic storms in 19 patients as anotherserious complication.Conclusions. All the observed arrhythmic episodes were ventricular tachycardias (p

Key words:
implantable cardioverter-defibrillators, inappropriate therapy, arrhythmic storm, proarrhythmia.