Objectives: To demonstrate our results of cardioverter-defibrillator implantations in patients with chronic heart failure to prevent sudden cardiac death.
Materials and Methods: From 2011 to 2013 in our center there were implanted 42 cardioverter-defibrillators, including 29 men (age 49 ± 13.7 years) and 13 women (age 45 ± 9.5 years). The main cause of high risk of sudden cardiac death (SCD) was ischemic heart disease with myocardial infarction (33 patients). 8 patients with dilated cardiomyopathy, and 1 patient had idiopathic ventricular tachycardia.10 patients with ischemic heart disease had a permanent atrial fibrillation, these patients received single-chamber ICDs. 30 patients out of 42 received CRT-D (implantable cardiac resynchronization therapy device with life-saving therapy to prevent sudden cardiac death) and 2 patients received dual chamber ICDs. 37 patients had indications for primary prevention of SCD. 5 patients had indications for secondary prevention of SCD, who had recorded episodes of sustained ventricular tachycardia and required emergency intervention. All patients were followed up. Testing and reprogramming of ICDs and CRT-Ds were carried out in terms of 3, 6 and 12 months, as well as after initial implantation and after device delivering therapy. During and post-operative complications were not observed. All patients received optimal heart failure drug therapy, including beta-blockers, ACE inhibitors, also diuretics and digoxin appropriately, when it is demand.
Results: 9 patients received ICD therapies. 4patients received inappropriate shocks in response to atrial fibrillation with rapid ventricular rate. After selection of antiarrhythmic therapy with amiodarone and digoxin and after correction of ICD tachycardia discrimination parameters, recurrent episodes of inappropriate shocks were not observed. The remaining 5 patients received appropriate ICD therapies as anti-tachycardia pacing (ATP) in one case, and in 4 cases defibrillation shock up to 34 joules in response to a stable ventricular tachycardia with a rate of 200-210 beats per minute.
Conclusions: Implantable cardioverter-defibrillators reduce mortality from life-threatening tachycardia in patients at high risk of SCD. Opportunely correction of ICD parameters with additional features of supraventricular tachycardia discrimination, appropriate treatment of the underlying heart disease and related tachyarrhythmia contribute to reduce the number of inappropriate shocks and improve the quality of life for patients.