Document Detail

Implantable cardioverter-defibrillator shocks: epidemiology, outcomes, and therapeutic approaches.
MedLine Citation:
PMID:  23546173     Owner:  NLM     Status:  MEDLINE    
IMPORTANCE: Implantable cardioverter-defibrillators (ICDs) have revolutionized the approach to the prevention of sudden cardiac death and are commonly used in a wide range of high-risk patients, including the large population of patients with severe left ventricular systolic dysfunction. The benefit of these devices derives from their therapies, including both antitachycardia pacing and high-energy shocks. However, although these therapies may be life saving, devices can also deliver inappropriate shocks.
OBJECTIVE: To review ICD therapies (shocks and antitachycardia pacing), their effects on health outcomes, and current methods to reduce these therapies.
EVIDENCE REVIEW: We reviewed clinical evidence on ICD shocks and reference lists of retrieved articles. We also examined literature about the methods of reducing ICD therapy.
FINDINGS: Both appropriate and inappropriate ICD shocks are common and are associated with an adverse effect on health outcomes, quality of life, and mortality. Several methods are available to reduce the risk of inappropriate ICD therapies.
CONCLUSIONS AND RELEVANCE: Implantable cardioverter-defibrillators reduce the risk of sudden cardiac death and prolong life in selected populations; however, many patients will receive an ICD shock, either appropriate or inappropriate. It is imperative that patients be counseled regarding this risk and adverse outcomes associated with shocks. Reduction of ICD shock should be individualized to ensure that patients receiving these devices experience the maximal benefits of therapy while minimizing the adverse consequences.
Ryan T Borne; Paul D Varosy; Frederick A Masoudi
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  JAMA internal medicine     Volume:  173     ISSN:  2168-6114     ISO Abbreviation:  JAMA Intern Med     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-05-28     Completed Date:  2013-07-22     Revised Date:  2014-01-27    
Medline Journal Info:
Nlm Unique ID:  101589534     Medline TA:  JAMA Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  859-65     Citation Subset:  AIM; IM    
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MeSH Terms
Anti-Arrhythmia Agents / administration & dosage,  adverse effects,  therapeutic use*
Atrial Fibrillation / complications
Catheter Ablation
Clinical Trials as Topic
Death, Sudden, Cardiac / etiology,  prevention & control*
Defibrillators, Implantable* / adverse effects
Disease Progression
Evidence-Based Medicine
Health Status
Heart Failure / complications,  physiopathology,  therapy*
Middle Aged
Quality of Life*
Tachycardia, Ventricular / etiology,  physiopathology,  surgery,  therapy*
Treatment Outcome
Ventricular Function, Left
Reg. No./Substance:
0/Anti-Arrhythmia Agents
Comment In:
JAMA Intern Med. 2013 Dec 9-23;173(22):2093-4   [PMID:  24322466 ]
JAMA Intern Med. 2013 Dec 9-23;173(22):2094   [PMID:  24322468 ]

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