Device Therapy for the Management of Cardiac Tachyarrhythmias
Device Therapy for the Management of Cardiac Tachyarrhythmias
Implantation of devices that can terminate cardiac arrhythmias has increased rapidly over recent years. This article looks at the evidence base for using such devices in the primary and secondary prevention of sudden arrhythmic death, discusses who should have a device and examines the issues surrounding implantation. Recent advances in technology and the future direction of therapy are also reviewed.
Cardiovascular disease (CVD) is the main cause of death in the UK, accounting for nearly 198,000 deaths or around a third of all mortality. Many of these deaths are sudden and secondary to ventricular tachycardia or fibrillation. Indeed the annual incidence of sudden arrhythmic deaths has been estimated at between 184,000 and 462,000 (0.1–0.2% annual incidence) in the USA and event rates in Europe are similar.
Antiarrhythmic therapy has been shown to be ineffective in improving mortality in high-risk patients. Since Mirowski first described the use of the internal cardioverter–defibrillator (ICD) for termination of malignant ventricular arrhythmias in 1980, the use of these devices has been increasing. The publication of randomized controlled trial data over the past 15 years showing the efficacy of the ICD in reducing sudden cardiac death has led to a large increase in device implantation rates across Europe, with a 25% increase in ICD implantation in 2008 compared with 2007 seen in the UK.
An ICD is a device that can detect and successfully treat ventricular arrhythmias with anti-tachycardia pacing (ATP) and a defibrillation shock. This article reviews the trial evidence supporting the use of ICDs, discusses which patients should be considered for implantation and reviews issues surrounding implantation. It will also discuss current and future advances in ICD technology.
Abstract and Introduction
Abstract
Implantation of devices that can terminate cardiac arrhythmias has increased rapidly over recent years. This article looks at the evidence base for using such devices in the primary and secondary prevention of sudden arrhythmic death, discusses who should have a device and examines the issues surrounding implantation. Recent advances in technology and the future direction of therapy are also reviewed.
Introduction
Cardiovascular disease (CVD) is the main cause of death in the UK, accounting for nearly 198,000 deaths or around a third of all mortality. Many of these deaths are sudden and secondary to ventricular tachycardia or fibrillation. Indeed the annual incidence of sudden arrhythmic deaths has been estimated at between 184,000 and 462,000 (0.1–0.2% annual incidence) in the USA and event rates in Europe are similar.
Antiarrhythmic therapy has been shown to be ineffective in improving mortality in high-risk patients. Since Mirowski first described the use of the internal cardioverter–defibrillator (ICD) for termination of malignant ventricular arrhythmias in 1980, the use of these devices has been increasing. The publication of randomized controlled trial data over the past 15 years showing the efficacy of the ICD in reducing sudden cardiac death has led to a large increase in device implantation rates across Europe, with a 25% increase in ICD implantation in 2008 compared with 2007 seen in the UK.
An ICD is a device that can detect and successfully treat ventricular arrhythmias with anti-tachycardia pacing (ATP) and a defibrillation shock. This article reviews the trial evidence supporting the use of ICDs, discusses which patients should be considered for implantation and reviews issues surrounding implantation. It will also discuss current and future advances in ICD technology.