Investigation And Follow-up Of The Patients With ICD Indications

Objective:In recent years,there is a rapid development in the prevention field of the cardiac diseases,especially in hypertension and coronary heart disease. However,the incidence of sudden cardiac death(SCD) has not decreased obviously. SCD is still 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 or VF.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,and providing 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.Method:The investigation includes two parts.One is to select the patients who have ICD indications in wards of cardiology in Zhongshan Hospital from the period of June,2007 to June,2008.The other is to select the patients who were implanted with ICD or CRT-D in Zhongshan Hospital from the period of March,2004 to March, 2009.Collect their basic information and related medical history;Record the examination results and treatment state.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:The investigation includes two parts. One part:There were 152 patients attending the research,including 118 patients(77.6%) with the indications of primary prevention for SCD which is 3.5 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(42.4%),and the heart failure patients with OMI is in the second place (36.4%).While,among the secondary prevention patients,spontaneous organic heart diseases with sustained ventricular tachycardia are in the largest proportion(61.8%). There were 26 patients accepted ICD/CRT-D implantation,only eleven of them are primary prevention patients.The other part:There were 57 patients implanted with ICD/CRT-D.There were 23(40.4%) patients with the indications of primary prevention for SCD,while there were 34 patients with the indications of secondary prevention for SCD.Before 2008, there were hardly patients with secondary prevention for SCD.At 16.1±13.6 months of follow-up,no one died of sudden cardiac death.All-cause mortality of patients with ICD implantation is lower than that of patients without ICD implantation,which difference with statistical significance (P＜0.05).Conclusions:Through the research,we found that the clinical applications of ICD as the prevention for SCD are far below its indication rate,especial the primary prevention.In China,there are more patients with the indications of primary prevention for SCD than those who with the indications of secondary prevention for SCD.Inversely,people who implanted with ICD/CRT-D are the patients with second prevention by majority.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.