Managing Ventricular Tachyarrhythmias In The Developing World: Insights From Recent ICD Trials

Talwar, K.K and Naik, N (2002) Managing Ventricular Tachyarrhythmias In The Developing World: Insights From Recent ICD Trials. [Journal (Paginated)]

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Since the introduction of the implantable cardioverter defibrillator (ICD) by Michel Mirowski in the 1980's, these devices have become an important tenet in management of ventricular arrhythmias1. Numerous observational and randomized trials have demonstrated the superiority of this device over antiarrhythmic drugs in treating ventricular arrhythmias. The clinical implications of these trials are tremendous as sudden cardiac death (SCD) maybe the presenting symptom in these arrhythmias. It is estimated that in the United States alone around 350,000 deaths occur each year due to SCD alone2 . As resuscitation is seldom successful in the community, methods to identify and appropriately treat such patients alone can prevent these events. However, the public health impact of this approach is tremendous, as the ICD is extremely expensive and is out of reach for many individuals. Moreover, not all patients with structural heart disease and ventricular arrhythmias have a malignant outcome. Thus efforts to appropriately stratify patients according to their risk profile and accordingly advocate ICD implant has important fiscal implications for the state with meager health resources, especially in those patients in whom survival benefit with the ICD is modest.

Item Type:Journal (Paginated)
Keywords:Ventricular Tachyarrhythmias
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:4327
Deposited By: Indian Pacing and Electrophysiology, Journal
Deposited On:02 May 2005
Last Modified:11 Mar 2011 08:56

References in Article

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1. Mirowski M, Reid PE, Winkle RA, et al. Mortality in patient with implanted automatic defibrillators. Ann Intern Med 1983; 98: 585-8.

2. Myerburg RJ, Kessler KM, Castellanos A: Sudden cardiac death: Epidemiology, transient risk and intervention assessment. Ann Intern Med 1993, 119: 1187-97..

3. The AVID Investigators: A comparison of antiarrhythmic drug therapy with implantable-cardioverter defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med 1997,337: 1576-83.

4. Connolly SJ, Gent M, Roberts RS, et al for the CIDS Investigators: Canadian Implantable Defibrillator Study (CIDS). A randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation 2000, 101: 1297-1302.

5. Kuck KH, Cappato R, Siebels J, Ruppel R, for the CASH Investigators: Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest. The Cardiac Arrest Study (CASH). Circulation 2000, 102: 748-54.

6. O'Brien B, Connolly SJ, Goeree R, et al for the CIDS Investigators: Cost-effectiveness of the Implantable Cardioverter Defibrillator. Results from the Canadian Implantable Defibrillator Study (CIDS). Circulation 2001, 103: 1416-21.

7. Sheldon R, Connolly S, Krahn A, et al on behalf of the CIDS Investigators: Identification of patients most likely to benefit from implantable cardioverter-defibrillator therapy. Canadian Implantable Defibrillator Study. Circulation 2000, 101: 1660-4.

8. Domanski MJ, Sakseena S, Epstein AE, et al for the AVID Investigators: Relative effectiveness of the implantable cardioverter-defibrillator and antiarrhythmic drugs in patients with varying degrees of left ventricular dysfunction who have survived malignant ventricular arrhythmias. J Am Coll Cardiol 1999, 34: 1090-5.

9. Exner DV, Sheldon RS, Pinski SL, Kron J, Hallstrom AH, and the AVID Investigators. Do baseline characteristics accurately discriminate between patients likely versus unlikely to benefit from implantable defibrillator therapy? Evaluation of the Canadian Implantable Defibrillator Study implantable cardioverter defibrillator efficacy score in the Antiarrhythmics Versus Implantable Defibrillator Trial. Am Heart J 2001; 141: 99-104.

10. Moss AJ. Implantable cardioverter defibrillator therapy: the sickest patients benefit the most. Circulation 2000; 10: 1638-40.

11. Hallstrom AP, McAnulty JH, Wilkoff BL, et al for the Antiarrhythmics Versus Implantable Defibrillator (AVID) Trial Investigators: Patients at lower risk of arrhythmia recurrence: a subgroup in whom implantable defibrillators may not offer benefit. J Am Coll Cardiol 2001, 37: 1093-9.

12. Sarter BH, Finkle JK, Gerszten RE, Buxton AE: What is the risk of sudden cardiac death in patients presenting with hemodynamically stable sustained ventricular tachycardia after myocardial infarction? J Am Coll Cardiol 1996, 28: 122-9.

13. Brugada P, Talajic M, Smeets J, et al: The value of the clinical history to assess prognosis of patients with ventricular tachycardia or ventricular fibrillation after myocardial infarction. Eur Heart J 1989, 10: 747-52.

14. Carusco AC, Marcus FI, Hahn EA, Hartz VL, Mason JW and the ESVEM Investigators: Predictors of arrhythmic death and cardiac arrest in the ESVEM trial. Circulation 1997, 96: 1888-92.

15. Bocker D, Block M, Isbruch F, et al: Benefits of treatment with implantable cardioverter-defibrillators in patients with stable ventricular tachycardia without cardiac arrest. Br Heart J 1995, 73: 158-63.

16. Raitt MH, Renfroe EG, Epstein AE, et al for the AVID Investigators: "Stable" ventricular tachycardia is not a benign rhythm. Insights from the Antiarrhythmics Versus Implantable Defibrillators (AVID) registry. Circulation 2001, 103: 244-52.

17. Zipes DP: Implantable cardioverter defibrillator: A Volkswagen or a Rolls Royce. How much will we pay to save a life? Circulation 2001, 103: 1372-4.

18. Kerber R, Becker L, Bourland J, et al. Automatic external defibrillators for public access defibrillation: Recommendations for specifying and reporting arrhythmia analysis, algorithm, performance, incorporating new waveforms and enhancing safety. Circulation 1997; 95: 1677-82.


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