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Therapy with an implantable cardioverter defibrillator (ICD) in patients with coronary artery disease and dilated cardiomyopathy : benefits and disadvantages
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift)
ID
1194098
Author(s)
Schaer, B; Kühne, M; Koller, M T; Sticherling, C; Osswald, S
Therapy with an implantable cardioverter defibrillator (ICD) in patients with coronary artery disease and dilated cardiomyopathy : benefits and disadvantages
Journal
Swiss medical weekly : official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology
Contemporary guidelines refer to ICD implantation in patients who experienced ventricular tachycardia or fibrillation as secondary prevention, and in well-defined high risk groups as primary prevention. Randomised studies were performed in patients with coronary artery disease and in non-ischaemic cardiopathies, chiefly dilated cardiomyopathy. After four years' follow-up the absolute risk reduction was some 10% in secondary prevention and 8-20% in primary prevention, depending on the patient population. As only approx. 50% of ICD patients will receive appropriate therapies during long-term follow-up, reasonable risk stratification is crucial. However, apart from ejection fraction of <35%, all other echo- or electrocardiographic factors studied have thus far failed to have significant impact to determine risk in advance. In a retrospective analysis comorbidities such as advanced age, renal failure and atrial fibrillation have been shown to influence the effect of an ICD. During long term follow-up inappropriate shocks, lead complications, premature battery depletion and anxiety are some of the most significant problems for an ICD patient.
