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Posts Tagged ‘implantable cardiovertor defibrillator’

This post , is  probably not meant for cardiology professionals.

Few technologies are clear winners in modern medicine. ICDs play  games  that would rival the God !

What is an ICD ?

Here is a man , who  drops almost dead by a fatal cardiac arrhythmia . In few seconds  ICD  machine recognises this arrhythmia ,charges itself and  fires a shock  of about 30 joules direct current .The arrhythmia is reverted and the fellow gets up as if  nothing has happened !

Watch this video

This revolutionary devices are  to be used judiciously in individuals with high risk  for dangerous cardiac arrhythmia.

The current  indications  as on 2012

Post MI  ( Only after  4O days*)
LV dysfunction EF ≤ 35%   NYHA  II or III  ( Please note , If  ≤ 30%, even Class I  NYHA can be implanted an ICD) *Why 40 days ?  Residual ischemic, Irritable  focus  should settle down
Myocardial disease
  • Nonischemic DCM  EF ≤ 35% with documented VT
  • Rarely other structural heart disease with recurrent risk for VT ( Few HCMs)
Primary electrical disease
  • Survivors of cardiac arrest due to VF without any completely reversible causes (Includes Brugada )
  • Malignant forms of syncope  with   idiopathic recurrent VT /VF
  • Congenital Long QT syndromes not amenable to beta blockers

Reference

Guidelines ICD pacemaker 2012 ACC AHA

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ICDs have revolutionizes the management of refractory VT   and in the  prevention of  sudden cardiac deaths in vulnerable population.Every year  100s of  thousand    ICDs are    implanted . Three  industry leaders are providing  state of  art  machines. The technology is evolving . Till recently , the  shocking leads of ICD has  a separate connectors  called DF1 .

Now,  we have all 4 leads incorporated into one lead  connector called  DF 4 . It has gained tremendous interest  among cardiologist and stand alone electro-physiologists  . The reason is simple  – Ease  of   implantation !

Does the  ease of implanting  do compromise   the  efficiency of ICD  system ?

I am surprised by this article . Here is an  excellent analysis by a truth seeking   electro-physiologist  about the   genuine issues of ICD implantation  especially to potential problems with  DF 4 interface .

http://www.cardioexchange.org/voices/new-icd-lead-technology-creates-new-set-of-problems-a-perspective-from-one-electrophysiologist/

A related article .

https://drsvenkatesan.wordpress.com/wp-admin/post.php?post=19708&action=edit

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