open access

Vol 63, No 10 (2005)
Other
Published online: 2005-10-21
Submitted: 2012-12-28
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ORIGINAL ARTICLE
Implantable cardioverter-defibrillators in patients with hypertrophic cardiomyopathy – dilemmas and difficulties

Andrzej Przybylski, Longina Małecka, Mariusz Pytkowski, Lidia Chojnowska, Michał Lewandowski, Maciej Sterliński, Aleksander Maciąg, Witold Rużyłło, Hanna Szwed
Kardiol Pol 2005;63(10):391-397.

open access

Vol 63, No 10 (2005)
Other
Published online: 2005-10-21
Submitted: 2012-12-28

Abstract

Introduction: The implantation of a cardioverter-defibrillator (ICD) is an established method of sudden cardiac death (SCD) prevention. The value of ICD therapy in secondary prevention of SCD is unquestionable. Precise identification of high-risk patients and ICD use for primary prevention of SCD, especially in patients with hypertrophic cardiomyopathy (HCM), remain controversial. Problems include the high prevalence of complications associated with ICD implantation and optimal selection of ICDs. Aim: To estimate the frequency and type of complications after ICD implantations in HCM patients in a long-term follow-up. Method: The efficacy and safety of ICD therapy were estimated in 46 HCM patients with devices implanted for a secondary (n-18) or primary prevention (n-28) of SCD. Results: During the mean follow-up period of 28.2±26.1 months (from 2 to 68) appropriate ICD interventions occurred in 10 (55%) patients of the secondary prevention group and in 3 (10%) patients of the primary prevention group. Complications were documented in 15 (33%) patients. The most frequent were inappropriate ICD interventions recorded in 14 (30%) patients. The causes of these inappropriate ICD shocks were: T-wave oversensing (7 patients), atrial fibrillation with rapid ventricular rhythm (3 patients), lead failure (2 patients), and sinus tachycardia (2 patients). In two patients infections of the ICD pocket requiring removal of the system occurred. Displacement of the lead occurred in one patient. There were no significant differences in the prevalence of complications between the primary and secondary prevention groups or in the number of inappropriate interventions with respect to ICD type. Conclusions: The high rate of appropriate ICD shocks provides proof of high ICD-based SCD prevention efficacy. There is a high rate of complications observed after ICD implantation with inappropriate interventions being the most frequent among them. This indicates that careful programming of the device as well as the use of a programme with T-wave oversensing prevention should be ensured.

Abstract

Introduction: The implantation of a cardioverter-defibrillator (ICD) is an established method of sudden cardiac death (SCD) prevention. The value of ICD therapy in secondary prevention of SCD is unquestionable. Precise identification of high-risk patients and ICD use for primary prevention of SCD, especially in patients with hypertrophic cardiomyopathy (HCM), remain controversial. Problems include the high prevalence of complications associated with ICD implantation and optimal selection of ICDs. Aim: To estimate the frequency and type of complications after ICD implantations in HCM patients in a long-term follow-up. Method: The efficacy and safety of ICD therapy were estimated in 46 HCM patients with devices implanted for a secondary (n-18) or primary prevention (n-28) of SCD. Results: During the mean follow-up period of 28.2±26.1 months (from 2 to 68) appropriate ICD interventions occurred in 10 (55%) patients of the secondary prevention group and in 3 (10%) patients of the primary prevention group. Complications were documented in 15 (33%) patients. The most frequent were inappropriate ICD interventions recorded in 14 (30%) patients. The causes of these inappropriate ICD shocks were: T-wave oversensing (7 patients), atrial fibrillation with rapid ventricular rhythm (3 patients), lead failure (2 patients), and sinus tachycardia (2 patients). In two patients infections of the ICD pocket requiring removal of the system occurred. Displacement of the lead occurred in one patient. There were no significant differences in the prevalence of complications between the primary and secondary prevention groups or in the number of inappropriate interventions with respect to ICD type. Conclusions: The high rate of appropriate ICD shocks provides proof of high ICD-based SCD prevention efficacy. There is a high rate of complications observed after ICD implantation with inappropriate interventions being the most frequent among them. This indicates that careful programming of the device as well as the use of a programme with T-wave oversensing prevention should be ensured.
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Keywords

implantable cardioverter-defibrillator; hypertrophic cardiomyopathy

About this article
Title

ORIGINAL ARTICLE
Implantable cardioverter-defibrillators in patients with hypertrophic cardiomyopathy – dilemmas and difficulties

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 63, No 10 (2005)

Pages

391-397

Published online

2005-10-21

Bibliographic record

Kardiol Pol 2005;63(10):391-397.

Keywords

implantable cardioverter-defibrillator
hypertrophic cardiomyopathy

Authors

Andrzej Przybylski
Longina Małecka
Mariusz Pytkowski
Lidia Chojnowska
Michał Lewandowski
Maciej Sterliński
Aleksander Maciąg
Witold Rużyłło
Hanna Szwed

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