4 It remains a matter of debate if this finding depends on the context of a specific cardiac substrate or the shock per se. 3Ĭurrent evidence suggests that ICD shocks increase the risk of mortality. 2 Shocks, whether appropriate or not, tend to occur frequently after the implantation of an ICD and avoiding shocks is a reasonable therapeutic target. ICD shocks can be painful if experienced in the awake state and may reduce quality of life in affected patients. Furthermore, technical problems such as lead fractures, oversensing of myopotentials or external noise can lead to shock application. The ability of an ICD to correctly detect this arrhythmia is essential to avoid shock delivery. In cases of inadequate arrhythmia classification by the device, atrial fibrillation (AF) with rapid conduction to the ventricles can lead to inappropriate shocks. 1 However, the efficacy of an ICD depends on its ability to correctly detect ventricular arrhythmia and deliver antitachycardia pacing or shocks. ICD therapy prolongs life in both patient populations. The first indications for ICD placement were secondary prevention later trials demonstrated a primary prevention benefit of ICD therapy in patients at risk of SCD. Implantable cardioverter defibrillators (ICDs) have been used for over 30 years to prevent sudden cardiac death (SCD).
This review article summarises current knowledge regarding the antiarrhythmic management of patients with ICDs. Few prospective randomised trials are available, but current data suggest that amiodarone is most effective for prevention of appropriate or inappropriate ICD shocks. Some drugs could eventually influence the function of ICDs by altering defibrillation or pacing threshold. Therapeutic agents such as β-blockers, class I or class III antiarrhythmic drugs effectively suppress arrhythmias, but may have side-effects. Accordingly, ICD discharges occur frequently and many patients with an ICD will need concomitant antiarrhythmic drug therapy to avoid or reduce the frequency of shocks. On the other hand, in this population the incidence of atrial fibrillation, giving rise to inappropriate ICD shocks, is high. Many patients receiving an ICD are affected by heart failure and are at risk of ventricular arrhythmias, which may lead to appropriate shocks.
Implantable cardioverter defibrillators (ICDs) are effective in the prevention of arrhythmic sudden cardiac death.
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