Sudden Cardiac Death Prevention with Implantable Cardioverter Defibrilator

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Sudden cardiac death is one of the major causes of death in developed country. Each year, it kills more than 3 million people. Sudden cardiac death, sometimes called SCD, is the sudden and unexpected death of a person due to sudden cardiac arrest which occurred less than 1 hour before symptoms started in a person who doesn’t have previously fatal health condition.

There are several stages that precede the incidence of SCD. Few weeks or months before the occurrence of cardiac arrest, patients typically feel forerunner symptoms which are not specific. When the patient began to feel chest pain, palpitations, or sudden shortness of breath, cardiac arrest can be come in less than 1 hour. If not treated immediately, biological death will occur.

The link between coronary heart disease and sudden cardiac death

Sudden cardiac death is closely linked to coronary heart disease. It is a common consequence of coronary heart disease. In contrast, coronary heart disease, with or without heart attack, is major underlying cause of sudden cardiac death. In the United States, coronary heart disease is responsible for about 80% incidence of SCD. The remaining is usually caused by heart muscle disorder or heart’s electrical disturbances.

The incidence of sudden cardiac death increased with age, both in men and women. In addition, incidence of sudden cardiac death in men is higher than in women. Around 75% of all sudden cardiac death occurs in men. Moreover, sudden cardiac death rates in men are 3 to 4 times higher than in women. The major risk factor of sudden cardiac death is the lack of blood pumped by the heart that led to symptoms of heart failure, such as shortness of breath.

In general, the risk factor of sudden cardiac death is the same as the risk factor of coronary heart disease, such as age, diabetes mellitus, blood pressure, ECG abnormality, vital capacity, overweight, tobacco use, and high cholesterol. Tobacco use is an important risk factor of sudden cardiac death. A study shows that tobacco use can lead to formation of thrombus in coronary arteries. Another study proofs that the annual incidence of sudden cardiac death increased from 13 per 1000 people in people who do not smoke to almost 2.5-fold in people who smoked > 20 cigarettes/day.

Another risk factor is strenuous exercise among sedentary people. During vigorous activity, blood clotting cells become stickier that can result in heart attack which led to sudden cardiac death. The incidence exercise-related SCD is about 1 in 200.000 to 250.000 among sedentary people without known heart disease. In contrarily, people with habitual exercise had a substantially lower risk of sudden cardiac death compared with sedentary people.

How to prevent sudden cardiac death?

Nowadays, prevention of sudden cardiac death can be achieved either with drugs, surgical therapy and use of a defibrillator to help the heart beat in accordance with its normal rhythm. Surgical therapy is not preferable options because it is too invasive and has a lot of risk. Presently, less invasive defibrillator has been developed, known as implantable cardioverter defibrillator (ICD)

Implantable Cardioverter Defibrillator (ICD)

ICD is battery-powered device that is placed under skin to help the heart beats in accordance with its normal rhythm. First developed in early 1990s, now ICD gain its superiority compared to drugs since it has been proved by some research conducted in 1997 to 2000.

ICD technology has been developed progressively. Initially, ICD has a large size thus open chest surgery is needed to insert it. Moreover, first generation ICD cannot be programmed although it can normalize abnormal rhythm. Today, device size has been reduced so that it can be implanted without massive surgery. Other improvements are newer and more effective waveform, multiprogramming, and can also function as a pacemaker.

ICD will be very useful in preventing sudden cardiac death if used in patients who have history or risk of life-threatening arrhythmia, such as ventricular fibrillation or ventricular tachycardia. Therefore, other correctable causes of arrhythmia must be ruled out before implanting ICD to patients. Patients will be recommended to be installed ICD if they have risk of life-threatening arrhythmia, such history of arrhythmia, heart attacks, cardiac arrest, congenital heart disease, or other conditions that can cause cardiac arrest.

ICD connected to the heart by wires. If abnormal heart rhythm is detected, device will deliver an electric shock to restore normal heart rhythm.

If someone is using ICD, then he should pay attention to the environment, including electronic equipment located in the vicinity. Some electronic devices have large magnetic waves that can interfere with the ICD. Here are some of the electronic device should be adjusted when someone is using ICD.

– Household appliances, such as microwave, electric generators, magnetic mattresses or pillows, fat measurement scale.
– Other electronic devices, such as mobile phones, MP3 players
– Metal detectors
– Medical equipment, such as Magnetic Resonance Imaging (MRI), Extracorporeal Shock-Wave Lithotripsy (ESWL), and electro cauterization which used to stop bleeding during surgery.

People using the ICD will also be given a card by the hospital regarding the description of the device used. The card is used one of them if someone attached ICD going to travel by plane.
People using the ICD will also be given a card by the hospital regarding the description of the device used. The card is useful if patient implanted with ICD are going to travel by plane.
Today, Cardiology Division has performed many procedures to implant devices in order to overcome arrhythmia cases.

References:
• Tester DJ, Ackerman MJ. Genetics of Cardiac Arrhythmias. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, editors. Braunwald’s Heart Disease : A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia: Elsevier Saunders; 2012. p. 81-90.
• Josephson M, Wellens HJ. Implantable defibrillators and sudden cardiac death. Circulation. 2004;109(22):2685-91.
• Zipes DP, Wellens HJ. Sudden cardiac death. Circulation. 1998;98(21):2334-51.
• Myerburg RJ, Castellanos A. Cardiac Arrest and Sudden Cardiac Death. In: Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, editors. Braunwald’s Heart Disease : A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia: Elsevier Saunders; 2012. p. 845-84.
• Burke AP, Farb A, Malcom GT, Liang YH, Smialek J, Virmani R. Coronary risk factors and plaque morphology in men with coronary disease who died suddenly. N Engl J Med. 1997;336(18):1276-82.
• A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. The Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. N Engl J Med. 1997;337(22):1576-83.
• Connolly SJ, Gent M, Roberts RS, Dorian P, Roy D, Sheldon RS, et al. Canadian implantable defibrillator study (CIDS) : a randomized trial of the implantable cardioverter defibrillator against amiodarone. Circulation. 2000;101(11):1297-302.
• Kuck KH, Cappato R, Siebels J, Ruppel R. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest : the Cardiac Arrest Study Hamburg (CASH). Circulation. 2000;102(7):748-54.
• Implantable Cardioverter Defibrillator (ICD)2014 December 9, 2014]: Available from: http://www.heart.org/HEARTORG/Conditions/Arrhythmia/PreventionTreatmentofArrhythmia/Implantable-Cardioverter-Defibrillator-ICD_UCM_448478_Article.jsp.

Posted: February 21, 2016 at 12:07 am, Last Updated: February 21, 2016 at 12:12 am

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