Investigation And Follow-up Of The Patients With ICD Indications

Objective:Sudden cardiac death(SCD) is an enormous public health problem around world.Implantable Cardioverter Defibrillator(ICD) has become mainstream therapy for the prevention of SCD from ventricular tachyarrthythmias.A decade of studies has confirmed the superiority of ICD over antiarrhythmic drug therapy in prolonging the life of patients with a prior history of sustained VT of VF.More recent studies have compared ICD therapy to drugs or no antiarrhythmic therapy as "primary prevention" in patients considered at high risk for sudden death or with prior MI.In selected patients,ICD leads to important relative and absolute reductions in mortality in patients with no prior history of sustained VT or VF.In China,there are numerous patients who accord with the indications of ICD,however,compared with the European and American countries,the number and percentage of ICD implantation is extraordinary low.Furthermore,the lack of epidemiology and clinical trials also impacts of the ICD applications in China.Therefore,the research is aimed at understanding the composition of Chinese patients who with ICD indications,the application of ICD in the primary and second prevention for SCD,the reasons and influences of refusal to accept ICD,and to provide basis for improving the situation of acceptance rate of ICD in China,through the investigation of some inpatients who have ICD indications in wards of cardiology in Zhongshan Hospital.Methods:Select the patients who have ICD indications in wards of cardiology in Zhongshan Hospital from the period of June,2007 to January 2008.Collect their basic information and related medical history;Record the examination results and treatment state;In addition,a questionnaire survey to the patients,their families,and the attending doctors was conducted.Then,through the telephone and out-patient follow-up,we can get the information of vicious incidents or death of the patients,and also the working conditions of the ICDs.Results:There were 122 patients attending the research,including 89 patients (73.0%) with the indications of primary prevention for SCD.which is 2.7 times to the patients with the indications of the secondary prevention.In the primary prevention patients,chronic heart failure caused by non-ischemic heart disease is the most common(51.7%),and the heart failure patients with OMI is in the second place (20.2%),which is different from the information abroad.While,among the secondary prevention patients,spontaneous organic heart diseases with sustained ventricular tachycardia(VT) are in the largest proportion(63.6%).There were 16 patients accepted ICD/CRT-D implantation,only two of them are primary prevention patients. Through the research we knew that in the aspect of the recognition of SCD and the acceptance of ICD,patients of secondary prevention are much better than the primary prevention ones,which difference with statistical significance(P＜0.001).When come along with making the decision of whether accepted ICD implantation,the suggestions of physicians play an important role.51.8%of the patients who did not accept ICD implantation said,the main reason they rejected ICD treatment is they do not think is needed at all,and 93.9%physicians of the primary prevention patients had never introduced ICD treatment for the same reason,which is much higher than the secondary prevention(P＜0.001).At 7.7±2.2 months of follow-up,8 patients died without ICD implantation,4 of which was supposed to be SCD,and the overall mortality is 8.9%.Three of the patients with ICD implantation had the rapid ventricular arrhythmias,and the incident rate is 20%.Conclusions:Through the research,we found that the clinical applications of ICD as the prevention for SCD are far below its indication range,especial the primary prevention.The lack of understanding for ICD indications of a lot of clinicians has taken a direct influence on the ICD acceptance extent of the primary prevention patients,and has become the second important reason other than economic factor for the low implanted rate of ICD.Therefore,to accelerate the development of ICD in China,strengthen ICD knowledge education,especially in the aspect of ICD as the primary of SCD prevention application is needed.And during the follow-up,we can find that ICD can reduce the overall mortality and the sudden death.