Implantable cardioverter defibrillator – powerful weapon in primary and secondary prevention of sudden cardiac death

Tomislav Kostic; Dragana Stanojevic; Ognjen Gudelj; Dragan Milić; Svetozar Putnik; Zoran Perisic; Boris Djindjic; Milan Pavlovic; Goran Koracevic; Mladjan Golubovic; Vladimir Mitov; Stefan Momcilovic; Sanja Bankovic

doi:10.2298/VSP171003010K

Tomislav Kostic Clinical Centre Niš, Clinic for Cardiovascular Diseases, Niš, Serbia
Dragana Stanojevic Military Medical Academy, †Clinic for Cardiology, Belgrade, Serbia
Ognjen Gudelj Military Medical Academy, Clinic for Cardiology, Belgrade, Serbia
Dragan Milić Clinical Centre of Serbia, Clinic for Cardiac Surgery, Belgrade, Serbia
Svetozar Putnik Clinical Centre of Serbia, Clinic for Cardiac Surgery, Belgrade, Serbia
Zoran Perisic Clinical Centre Niš, Clinic for Cardiovascular Diseases, Niš, Serbia
Boris Djindjic Clinical Centre Niš, Clinic for Cardiovascular Diseases, Niš, Serbia
Milan Pavlovic Clinical Centre Niš, Clinic for Cardiovascular Diseases, Niš, Serbia
Goran Koracevic Clinical Centre Niš, Clinic for Cardiovascular Diseases, Niš, Serbia
Mladjan Golubovic Clinical Centre Niš, Clinic for Cardiothoracic and Transplantation Surgery, Niš, Serbia
Vladimir Mitov Health Centre Zaječar, Serbia
Stefan Momcilovic Health Centre Zaječar, Serbia
Sanja Bankovic Clinical Centre Niš, Clinic for Cardiovascular Diseases, Niš, Serbia

DOI: https://doi.org/10.2298/VSP171003010K

Keywords: death, sudden, cardiac, arrhythmias, cardiac, heart failure, defibrillators, implantable, drug therapy, pacemaker, artificial, mortality

Abstract

Abstract

Bacgraund/Aim. Sudden cardiac death (SCD) is one of the biggest problems of the contemporary medicine. Large studies showed that anti-arrhythmics, including amiodarone, are not effective in prevention of SCD in the patients with cardiac diseases who were on drug treatment. Those patients who received implantable cardioverter defibrillators (ICD) had better survival. The aim of this paper was to determine whether the patients receiving the ICD in the primary and secondary SCD prevention have longer survival than the patients treated exclusively with drug therapy. Methods. We included 1,260 patients with cardiac insufficiency and reduced left ventricular ejection fraction (LVEF < 35%) who were at high risk for malignant ventricular arrhythmias and SCD. Five hundred forty patients received ICD therapy. The cardiac resynchronization therapy – CRT/ICD group (n = 270) comprised the patients with cardiac insufficiency and CRT/ICD pacemaker at an optimal medical therapy. In the control group (n = 450), there were the patients with cardiac insufficiency (NYHA functional class 3–4, LVEF ≤ 35%, QRS duration ≥ 130 ms), at optimum drug therapy. Results. In the ICD group, there was a statistically significant increase in end-systolic volume (ESV) from 92.68 mL to 99.05 mL. In the group of patients with cardiac insufficiency who were on drug therapy, there was a significant decrease in LVEF (33.15% vs. 30.2%; p = 0.017), 6-minute walk distance (6 MWT distance) (216.55 m vs. 203.27 m, p = 0.003). In the same group, there was an increase in the values of ESV (90.19 mL vs. 95.41 mL; p = 0.011). An increase in the mortality rate in the group of patients with drug therapy compared to the CRT/ICD and ICD groups was statistically significant (p < 0.05). Conclusions. An ICD pacemaker implantation significantly reduces mortality compared to medical therapy only. In addition, the patients who have CRT in addition to ICD pacemaker, have a significantly better quality of life and increase in LVEF.

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