Interventions to decrease the morbidity and mortality associated with implantable cardioverter-defibrillator shocks.
OBJECTIVE
Implantable cardioverter-defibrillator (ICD) implantation is the standard of care for secondary prevention in patients with previous cardiac arrest and for primary prevention in appropriately selected patients with cardiomyopathy. However, ICD therapies and the arrhythmias that trigger these therapies cause decreased quality of life as well as increased morbidity and mortality. In this review, we summarize the recent evidence for interventions that may prevent ICD therapies.


RESULTS
Pharmacologic therapy remains central to prevent ICD shocks, but there is limited new evidence for drug therapies. Programming techniques continue to evolve which decrease the risk of inappropriate shocks. Cardiac resynchronization therapy (CRT) improves quality of life and decreases mortality, at least in part because of decreased arrhythmia burden. Procedures such as catheter ablation of ventricular tachycardia and procedures to modulate the autonomic nervous system can help minimize ICD therapy.


CONCLUSIONS
Pharmacologic therapy and appropriate device programming remain essential to the overall care of ICD patients. The role of CRT continues to grow as we gain a better understanding of its benefits. Advancements in the fields of catheter ablation and new understanding of the autonomic nervous system's effects on ventricular arrhythmias allow interventions to decrease the frequency of ICD shocks.
UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. jbradfield@mednet.ucla.edu
Jason S
JS
Bradfield
Eric
E
Buch
Kalyanam
K
Shivkumar
D001341:Autonomic Nervous System; D058406:Cardiac Resynchronization Therapy; D009202:Cardiomyopathies / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000706:statistics & numerical data; D004868:Equipment Failure; D006323:Heart Arrest / Q000601:surgery / Q000628:therapy*; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control; D011322:Primary Prevention; D055502:Secondary Prevention; D017180:Tachycardia, Ventricular / Q000601:surgery / Q000628:therapy*