Acompanhamento clínico de pacientes portadores de cardioversor-desfibrilador implantável

Abstract

Objective: To report appropriate (AT) and inappropriate (IT) ICD therapies in patients with ischemic and nonischemic heart disease, as well as early and late procedure-related complications. Methods:One hundred and fifty-five patients (119 male and 36 female), mean age 47 years (21-88), who underwent ICD implantation between 1994 and March 2003 were analyzed. Patients were divided into the following groups: Group I -Post-AMI patients (n = 80); Group II -Patients with nonischemic heart disease and LV ejection fraction < 40% (n = 45), Chagas disease (n = 18), idiopathic dilated cardiomyopathy (n= 12), hypertensive disease (n = 8), hypertrophic cardiomyopathy (n = 4) and valvular heart disease (n = 3); Group III -Patients with arrhythmogenic right ventricular dysplasia (n = 13); and Group IV -Patients with channelopathies: Brugada Syndrome (n = 8) and idiopathic ventricular arrhythmias (n = 9). All patients underwent EPS before ICD implantation.Results: During the 26-month mean follow up, a high rate of appropriate ICD therapies (antitachycardia pacing and/or shock) was observed (46%) in the four groups, with no statistically significant difference. The four groups did not differ in either overall (8.4%) or arrhythmic mortality (1.3%). There was no correlation between appropriate ICD therapies and initial clinical presentation or inducible ventricular arrhythmia at EPS, and a 4% incidence of early and late procedure-related complications was found. Conclusion:The high incidence of appropriate ICD therapy and low rate of sudden death in the patients studied suggest that ICD is a valuable strategy in the management of ischemic and nonischemic patients previously selected by means of EPS.Key words: Sudden death, implantable cardioverter-defibrillator, appropriate and inappropriate discharges, ischemic and nonischemic heart disease.

Cohort of Patients Referred for Brugada Syndrome Investigation in an Electrophysiology Service - 19-Year Registry

“…In the present study, the rate of the implantable device events was lower than that reported in the literature, including national studies with patients with BrS, 20 and the one patient with appropriate therapy received it in the first year of follow-up. Nevertheless, the mean 5-year follow-up showed a temporal gain as compared to many similar studies, allowing for the analysis of events in a larger time window - knowing that the risks are continuous throughout life - with the potential advantage of overcoming occasional inaccurate clinical data, manly family history, because the information is patient-dependent and previous data might not be well characterized in the generation immediately before the proband.…”

Clinical Course After Cardioverter-Defibrillator Implantation: Chagasic Versus Ischemic Patients

“… 21 There are only two studies with opposite findings, showing no difference regarding appropriate shock or therapy between chagasic and non-chagasic patients. 23 , 24 The difference in results might be attributed to the small number of chagasic patients included in those two studies (10 and 18, respectively).…”

A rotina ocupacional de pacientes implantados com cardiodesfibriladores

“…Quanto ao acompanhamento clínico de pacientes portadores do CDI no HUCFF, sabe-se que depois do implante do aparelho e a alta hospitalar, que acontece entre 24 a 48 horas após a cirurgia, são realizadas avaliações periódicas desses pacientes, pela equipe médica, a 7, 15 e 30 dias da intervenção. Depois desse primeiro mês, os pacientes são avaliados a cada três meses quanto aos acionamentos do CDI, quando também é acessada a mortalidade global e arrítmica dos portadores do aparelho (FONSECA et al, 2007).…”