Clinical follow-up of patients with implantable cardioverter-defibrillator.
OBJECTIVE
To report appropriate (AT) and inappropriate (IT) ICD therapies in patients with ischemic and nonischemic heart disease, as well as early and late procedure-related complications.


METHODS
One hundred and fifty-five patients (119 male and 36 female), mean age 47 years (21-88), who underwent ICD implantation between 1994 and March 2003 were analyzed. Patients were divided into the following groups: Group I--Post-AMI patients (n = 80); Group II--Patients with nonischemic heart disease and LV ejection fraction < 40% (n = 45), Chagas disease (n = 18), idiopathic dilated cardiomyopathy (n= 12), hypertensive disease (n = 8), hypertrophic cardiomyopathy (n = 4) and valvular heart disease (n = 3); Group III--Patients with arrhythmogenic right ventricular dysplasia (n = 13); and Group IV--Patients with channelopathies: Brugada Syndrome (n = 8) and idiopathic ventricular arrhythmias (n = 9). All patients underwent electrophysiological study (EPS) with induction of sustained ventricular arrhythmia ICD implantation.


RESULTS
During the 26-month mean follow up, a high rate of appropriate ICD therapies (antitachycardia pacing and/or shock) was observed (46%) in the four groups, with no statistically significant difference. The four groups did not differ in either overall (8.4%) or arrhythmic mortality (1.3%). There was no correlation between appropriate ICD therapies and initial clinical presentation or inducible ventricular arrhythmia at EPS, and a 4% incidence of early and late procedure-related complications was found.


CONCLUSIONS
The high incidence of appropriate ICD therapy and low rate of sudden death in the patients studied suggest that ICD is a valuable strategy in the management of ischemic and nonischemic patients previously selected by means of EPS.
da Fonseca
Silvia Martelo Souza
SM
Hospital Universitário Clementino Fraga Filho, Clínica São Vicente, Rio de Janeiro, RJ, Brazil smartelo@openlink.com.br
Belo
Luiz Gustavo
LG
Carvalho
Hécio
H
Araújo
Nilson
N
Munhoz
Cláudio
C
Siqueira
Leonardo
L
Maciel
Washington
W
Andréa
Eduardo
E
Atié
Jacob
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000150:complications / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology*