Implantable cardioverter-defibrillator implantation for primary and secondary prevention: indications and outcomes

2017 ◽  
Vol 27 (S1) ◽  
pp. S126-S131 ◽  
Author(s):  
Justin M. Pick ◽  
Anjan S. Batra
Keyword(s):  
Primary Prevention ◽  
High Risk ◽  
Sudden Cardiac Death ◽  
Secondary Prevention ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Death ◽  
Implantable Cardioverter Defibrillators ◽  
Cardioverter Defibrillator ◽  
Device Implantation ◽  
Risk Event

AbstractImplantable cardioverter-defibrillators effectively reduce the rate of sudden cardiac death in children. Significant efforts have been made to better characterise the indications for their placement, and over the past two decades there has been a shift in their use from secondary to primary prevention. Primary prevention includes placement in patients thought to be at high risk of sudden cardiac death before the patient experiences any event. Secondary prevention includes placement after a high-risk event including sustained ventricular tachycardia or resuscitated cardiac arrest. Although liberal device implantation may be appealing even in patients having marginal indications, studies have shown high rates of adverse effects including inappropriate device discharges and the need for re-intervention because of hardware malfunction. The indications for placement of an implantable cardioverter-defibrillator, whether for primary or secondary prevention of sudden cardiac death, vary based on cardiac pathology. This review will assist the provider in understanding the risks and benefits of device implantation in order to enhance the shared decision-making capacity of patients, families, and providers.

P989Incidence of appropriate implantable cardioverter defibrillator therapy and sudden cardiac death in cardiac sarcoidosis - a systematic review and meta-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Franke ◽  
H Marshall ◽  
P Kennewell ◽  
H D Pham ◽  
T Rattanakosit ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Secondary Prevention ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Death ◽  
Ventricular Arrhythmias ◽  
Cardiac Sarcoidosis ◽  
Meta Analysis ◽  
Cardioverter Defibrillator

Abstract Background Implantation of implantable cardioverter defibrillator (ICD) is a Class IIb indication in patients with Cardiac Sarcoid and with LVEF 36%-49% despite immunosuppression and optimal heart failure therapy. Purpose This systematic review and meta-analysis aimed to provide an estimate on the incidence of ventricular arrhythmias and risk of sudden cardiac death (SCD) in patients with CS. Methods The terms “Cardiac Sarcoidosis*” AND “Implantable Cardioverter Defibrillator” AND “Sudden Cardiac Death” were searched on PubMed, EMBASE, and Scopus on 21st of September 2018 yielding 759 articles. After exclusions, 12 studies met inclusion criteria. Results The 12 studies consisted of 612 patients with CS of which 534 had ICD implanted for primary or secondary prevention. Assuming appropriate device therapy as a surrogate for SCD, the annual incidence of appropriate ICD therapies and SCD combined was 6.3% (95% CI; 3.5%-9.1%) in primary prevention cohorts, 11.6% (95% CI; 7.8%-15.3%) in secondary prevention cohorts, and 8.7% (95% CI; 6.0%-11.5%) in both cohorts. The mean left ventricular ejection fraction (LVEF) was pooled as 59±7 (n=155) in primary prevention cohorts and 48±15 (n=48) in secondary prevention cohorts. However, the LVEF was 35±13 (n=28) in those with appropriate ICD therapy, and 49±16 (n=47) in those with ICDs without therapy. Incidence of SCD in Combined Cohorts Conclusion The incidence of ventricular arrhythmias and SCD is high not only secondary but also in primary prevention cohorts of CS. This data supports the role of implanting ICDs for primary prevention in patients with CS with mild to moderate reduction in LVEF. Acknowledgement/Funding None

Secondary prevention of sudden cardiac death in ischaemic cardiomyopathy

ESC CardioMed ◽  
2018 ◽  
pp. 2337-2341
Author(s):  
Jens Cosedis Nielsen ◽  
Jens Kristensen
Keyword(s):  
Heart Failure ◽  
Cardiac Arrest ◽  
Heart Disease ◽  
High Risk ◽  
Sudden Cardiac Death ◽  
Secondary Prevention ◽  
Cardiac Death ◽  
Cardioverter Defibrillator ◽  
Ischaemic Cardiomyopathy ◽  
Life Threatening

The most common reason for sudden cardiac death is ischaemic heart disease. Patients who survive cardiac arrest are at particularly high risk of recurrent ventricular arrhythmia and sudden cardiac death, and are candidates for secondary prevention defined as ‘therapies to reduce the risk of sudden cardiac death in patients who have already experienced an aborted cardiac arrest or life-threatening arrhythmias’. The mainstay therapy for secondary prevention of sudden cardiac death is implantation of an implantable cardioverter defibrillator. Furthermore, revascularization and optimal medical therapy for heart failure and concurrent cardiovascular diseases should be ensured.

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