Vai trò của ICD ở người bệnh sau nhồi máu cơ tim

Role Of ICD Post-MI Patients With Heart Failure Anil Saxena Director & Clinical Head Cardiac Pacing & Electrophysiology Fortis Escorts Heart Institute, New Delhi INDIA VT After MI: Anatomy of Scar Underlying Arrhythmia of Sudden Death Primary VF 8% Torsades de Pointes 13% VT Bradycardia 62% Adapted from Bayés de Luna A Am Heart J 1989;117:151-159 17% Sudden Cardiac Death Sudden Cardiac Death The Chain Of Survival Time to Defibrillation • Recognize cardiac arrest • Activate emergency response • Call hospital / ambulance • Medical help arrives on scene • Locate victim and shock • Total Elapsed Time min 10 min 15 ICD: Placement Indications for ICD Therapy Class I (Post MI) • ICD therapy is indicated in patients with syncope of undetermined origin with clinically relevant, hemodynamically significant sustained VT or VF induced at electrophysiological study (Level of Evidence: B) ❖ Prior MI, history of syncope ❖ LVEF - Any EF ❖ Hemodynamically unstable VT on EP study What Changes Could Be Done? • More inclusions by identifying clinical situations which cause SCD risk ❖ Less than 40 day Post MI patients with low EF • Less liberal guidelines by better risk stratification ❖ Primary prevention population (some may not be benefitting) Case • 54 year male presents with acute anterior MI • Has sustained VT at 36 hours, DC shock given • Revascularization NOT done/possible/available • LVEF 25% Secondary Prevention: CAD—VF or Hemodynamically Unstable VT Associated With Acute ([...]... post-enrollment Cumulative Probability of Mortality (n=1232) ICD No ICD (Conventional Therapy) 49% 62% • 34% relative reduction in the risk of death at any interval among patients with a defibrillator as compared with patients without an ICD • Number needed to treat (NNT) • 8 at 8 years • 17 at 2 years • Analysis showed sustained benefit with primary ICD therapy in the MADIT II study population *median Circ... p-value 0.66 (0.56-0.78)