Indications o f implanted de fibrilation

pp 209-217

Abstract

Implantable cardioverters defibrillators are devices capable to detect and terminate ventricular tachycardias or fibrillations. Used for the treatment of severe ventricular tachyarrhythmias, their efficacy in preventing sudden death has been extensively proven. New. devices have antibradicardia and antitachycardia pacing capabilities. Consecutive and biphasic wave shocks dramatically diminished defibrillation thresholds. Reliable information about the circumstances where the implantable cardioverters defibrillators is used, is of utmost importance to avoid erroneous discharges. Although Holter capabilities are nowadays limited, they will became very useful especially in cases of sinus tachycardia or atrial fibrillation with fast ventricular response. Implantable cardioverters defibrillators has been proposed for the treatment of sudden death in cases of ventricular arrhythmias and depressed myocardial function plus poor drug tolerance, and also in those cases where lethal arrhythmias have no identifiable cardiac disease. But whatever the results of on-going trials using implantable cardioverters defibrillators technology may be, an unfavorable trend of mortality in implanted patients would never dissuade the clinician to implant his next patient at risk of an"unmerited" sudden death. A better profile is needed to identify the best candidates to a cardioverter defibrillator implantation on an individual basis. This tool still needs and deserves diagnostic development before we realize to which point it fundamentally changed the management o f our patients.