Estudo dos episodios de taquicardia detectados por desfibrilador automatico implantavel : implicações diagnosticas e terapeuticas

AUTOR(ES)
DATA DE PUBLICAÇÃO

2002

RESUMO

INTRODUCTION: The development of automatic implantable defibrillators has been fast in the last few years. A device initially conceived to treat patients with serious docummented arrhythmias is now more and more used to primary prevention of sudden cardiac death. There was a huge evolution in the size and capacity ofthe devices, but programming is still a matter of great concern, not only to avoyd innapropriate therapies, but also to make sure tOOtpotentially fatal arrhythmias will be correct1ytreated. OBJECTIVES: To test clinical usefullness of a standard programming of automactic implantable defibrillators by means of efficacy of detection and therapy parameters. PATIENTS AND METHODS: We analysed clinical data of 81 patients with an implanted defibrillator at the Hospital Clínico i Provincial ofBarcelona. From each episode we collected data such as the diagnosis ofthe arrhythmia, it s rate, onset, stability and response to therapy. RESUL TS: During a mean follow-up of 1336 patients/month (mean 16.49:t 12.65 months), 1081 episodes of arrhythmias were detected. Using the programmed algorhythm, the devices were able to correct1y detect al the 486 episodes of sustained ventricular tachycardia. A total of 440 of these were treated without delay. In 19 episodes, inicial stability was greater then 40 msec, and therapy was delayed a mean of 2:tl seconds until stability could acheive the programmed leveI for therapy. In 27, the Sudden Onset criteria was less then 9%, and the device delayed therapy for a mean of, 72:t34 seconds, until programmed Sustained Rate Duration was acheived. In none of these episodes therapy de1ay caouse syncope or near-syncope. Overall heart rate, Sudden Onset and Stability criteria sensibility was 92% and specificity was 96% for the diagnosis of sustained ventricular tachycardia. If Sustained Rate Duration is taken in account, sensibility of the algorhythm could reach 100%, with specifity of 83%. There were 486 episodes of ventricular tachycardia treated with antitachycardia pacing. The programmed algorhythm showed a total efficacy of93,6% (455 out of 486 episodes). Anti-tachycardia pacing was innefective in interrupting 12 out of 486 episodes (2,5%). In 9 ofthem, a single shock was able to tenninate the tachycardia. CONCLUSION: The used standard programming of implantable automatic defibrillators was safe and effective in detection and treatment of potentially fatal arrhythmias

ASSUNTO(S)

eletrocardiografia arritmia - diagnostico algoritmos arritmia - tratamento arritmia

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