삽입형 심실제세동기를 이식한 환자들의 경과 보고

Abstract

BACKGROUND AND OBJECTIVES: Several randomized studies have shown that the implantable cardioverter-defibrillator (ICD) is a very effective treatment modality for the primary and secondary preventions of sudden cardiac death. The purpose of this study was to analyze our initial experience of ICD implantation in patients who had experienced syncope or sudden cardiac death between 1997 and 2004.

SUBJECTS AND METHODS: Between Aug. 1997 and Feb. 2004, 28 patients who had undergone an ICD implantation at the Yonsei Cardiovascular Center were retrospectively analyzed.

RESULTS: There were 28 patients (24 men, 4 female), with a mean age of 48±13.1 (21-74) years. ICD implantation was performed in 2 and 26 patients for the primary and secondary preventions of sudden cardiac death. Eight patients (28.6%) had neither a structural heart disease nor an electrical disease, but 8 (28.6%) had Brugada Syndrome. Twelve patients (42.8%) presented with structural heart disease. The most frequent documented clinical arrhythmia was ventricular fibrillation, which occurred in 11 patients (39.3%). During the mean follow-up of 29.3 months, the were 60 events of tachyarrhythmia triggered shock; 25 of these were from inappropriate shock due to atrial fibrillation (1 6), sinus tachycardia (6) and farfield T wave sensing (3). Two patients died: one of stomach cancer and the other died suddenly without DC shock. An autopsy revealed a moderate amount of bloody pericardial effusion, but unknown hemodynamic significance.

CONCLUSION: The implant of an ICD is an effective measure for the secondary prevention of sudden cardiac death. Dual-chamber ICD is desirable for the prevention of inappropriate ICD shock for supraventricular tachyarrhythmias.