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Nonpharmacological therapy for malignant ventricular arrhythmias: Implantable defibrillator trials
Journal article   Peer reviewed

Nonpharmacological therapy for malignant ventricular arrhythmias: Implantable defibrillator trials

Sanjeev Saksena, Gunter Breithardt, Paul Dorian, H. Leon Greene, Nandini Madan and Michael Block
Progress in cardiovascular diseases, v 38(6), pp 429-444
01 May 1996
PMID: 8638024

Abstract

Implantable cardioverter-defibrillators (ICDs) are an important nonpharmacological option in the treatment of malignant ventricular arrhythmias. Technological advances in current devices permit nonthoracotomy implantation with transvenous lead systems using biphasic shocks. Decreasing device size has resulted in pectoral implantation. Battery longevity is still short in comparison with that of pacemakers. Lead failure rates as well as pacing thresholds are significantly higher than those for cardiac pacing lead systems. Other complications of ICD systems include infection, perforation, and thrombosis. The long-term performance of nonthoracotomy lead systems for ICD devices has now been extensively studied. Sudden death recurrence rates for these systems are less than 2% in 3 years and less than 5% at 5 years. Clinical trials with both monophasic and biphasic systems show a high degree of prevention of sudden death. Comparison of ICD outcome with that of drug therapy in three large retrospective studies and two small prospective randomized trials favors improved survival and sudden death prevention with device therapy. However, these studies need corroboration from large prospective trials. Two large prospective trials, CIDS and the AVID study, are now in progress to address this issue.

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Web of Science research areas
Cardiac & Cardiovascular Systems
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