Update of implantable cardioverter/defibrillator and cardiac resynchronization therapy in heart failure
| Autor: | Tapan G. Rami, Hue-Teh Shih |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
medicine.medical_specialty
Radiofrequency ablation medicine.medical_treatment Population Cardiac resynchronization therapy Sudden cardiac death law.invention law Internal medicine medicine Humans education Ventricular remodeling Randomized Controlled Trials as Topic Heart Failure education.field_of_study business.industry medicine.disease Implantable cardioverter-defibrillator Defibrillators Implantable Clinical trial Death Sudden Cardiac Heart failure cardiovascular system Cardiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | Current opinion in cardiology. 19(3) |
| ISSN: | 0268-4705 |
| Popis: | Purpose of review Heart failure prevalence is reaching epidemic proportion in the United States and is associated with significant morbidity and mortality. A large proportion of the mortality is the result of sudden cardiac death (SCD). Clinical trials have demonstrated the superiority of the implantable cardioverter/defibrillator (ICD) compared with antiarrhythmic drugs for secondary prevention of sudden cardiac death. Recent findings Recently, several clinical trials in primary prevention of sudden cardiac death in both ischemic and nonischemic heart failure have been completed. The 2002 guidelines for implantable cardioverter/defibrillator implantation were recently released as well. Adjunct therapy consisting of antiarrhythmic drugs or radiofrequency ablation is necessary in the subset of patients with implantable cardioverter/defibrillator that have frequent or intractable ventricular arrhythmias. An emerging new therapy in the heart failure population is cardiac resynchronization therapy, which coordinates right and left ventricular pacing in a subset of patients with interventricular conduction delay. Summary Several randomized clinical trials have demonstrated improvements in heart failure-related symptoms, exercise tolerance, and reversal of ventricular remodeling. Meta-analysis of these trials has also demonstrated mortality benefit. Patient selection, left ventricular pacing site, and optimal device programming are issues that need further investigation. Recent trials have also studied the compatibility between cardiac resynchronization therapy and implantable cardioverter/defibrillator as a single device. Finally, the DAVID trial has raised concerns of conventional right ventricular pacing and the risk of heart failure in a subset of patients. |
| Databáze: | OpenAIRE |
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