Abstract

CRUZ CRUZ, Flory; ARAYA GOMEZ, Vivien  and  GUTIERREZ SOTELO, Oswaldo. Cardiodesfibriladores automáticos implantables: experiencia inicial en Costa Rica. Rev. costarric. cardiol [online]. 2001, vol.3, n.1, pp.42-48. ISSN 1409-4142.

Sudden cardiac death (SCD) strikes 350.000 people per year in the United States. Less than 5% survives SCD. Ventricular tachycardia (VT) or fibrillation (VF) secondary to any cardiac etiology most often causes SCD.  In adults, coronary artery disease is the most common etiology. In children and young adults, SCD is caused by other etiologies. Recently, there are using some therapies for treating SCD:  drugs, ablative therapy and devices such as implantable cardioverter-defibrillator (ICD). In Costa Rica, we started control SCD with ICD since april, 1998. In our experience, we had eigth cases since that date until november, 2000. All of them had VT/FV with SCD, a class I for the implant of ICD (American Heart Association guidelines). We practiced electrophysiologic study before implant the ICDs. The follow up period was 15,5 months (range 5-31). During follow up, 75% was alive, and 25% death because of heart failure and extensive acute myocardial infarction, none of them because of a malignant arrhythmia. One of these patients had a Medtronic device and the other one has had a Guidant.  In 37,5% of cases, there was an appropiate discharge. One patient had more than one ICD discharge treating VT and FV and also one inappropiate discharge ( atrial fibrillation). The other two patients had appropiate discharge of their ICDs. Patients with VT and VF with SCD can be treated efective and safely with an ICD therapy. It is well known that we can not treat other cardiac etiologies of SCD with and ICD.  The cost/bennefit must be considered.

Keywords : implantable cardioverter- defibrillator; sudden cardiac death; Ventricular tachycardia; ventricular fibrillation.