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The implantable cardioverter defibrillator: Indications and follow-up.

INTRODUCTION
Sudden cardiac death (SCD) is a public health problem. In most cases, it is the consequence of ventricular arrhythmias. The only treatment of proven effectiveness is the implantable cardioverter defibrillator (ICD).


AIM
To describe indications for ICD implantation according to the underlying heart disease and report it's short and long-term results.


METHODS
We report a retrospective and descriptive study involving 90 patients implanted with an ICD in our facility collected between January 2003 and December 2014.


RESULTS
The average age of our population was 49 ± 15 years (14-76). A male predominance was noted (sex ratio: 6). Ischemic heart disease was the most common underlying heart disease found in 37% of cases. The average left ventricular ejection fraction was 43.5 ± 17.7%. A slight predominance of primary prevention was noted in our series (52%). Single, dual and triple chamber ICD were used in respectively 34%, 36% and 30% of cases. The use of triple chamber ICD was more frequent in cardiomyopathies and ischemic heart disease. Early complications were observed in 9 patients (10%). No deaths directly related to the ICD implantation procedure was observed in our series. The mean follow-up was 39.7 months (3-136). We recorded 14 deaths. The main cause of death was refractory heart failure. During follow-up, 16 patients (18%) received appropriate ICD shocks. The only predictor of appropriate therapies was the indication of ICD for secondary prevention (p=0,002). Twenty one patients (23%) had complications inherent to the implantation of ICD. The main complication was inappropriate shocks found in 11 patients (12%). The main cause of these shocks was supraventricular arrhythmias 68%). Ischemic heart disease (p = 0.001) and secondary prevention (p = 0.048) were significantly associated with the occurrence of inappropriate ICD shocks. The ICD was explanted after varying delays in 4 patients (4.4%).


CONCLUSION
The results of our study were comparable to major ICD studies and registries particularly in terms of procedural, late complications and the occurrence of appropriate ICD therapies.