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454 Cardio Diabetes Medicine 2017

Idnetifying The Right Patients Who Benefits

From AICD Implantation

Dr.Raja Selvaraj
Additional Professor, Department of Cardiology,
JIPMER, Puducherry

Abstract: critical to optimal utilisation of an AICD. This is based
Sudden cardiac death is a major cause of mortality all on identification of subgroups of patients who are at
over the world and in India. It is all the more significant high risk for sudden death in whom the risk of device
because many of these patients are young and have implantation will be less than the benefit offered
otherwise good quality of life. by the device. This article discusses the important
indications and major subgroups who benefit from
Ventricular arrhythmias have been established as AICD implant. This is not a comprehensive list of all
the leading cause of sudden cardiac death. After the indications.
various anti-arrhythmic drugs were found to provide
no protection against sudden death, the automatic Secondary prevention:
implantable cardioverter defibrillator (AICD) has
emerged as an effective method to prevent sudden Patients who have survived a prior cardiac arrest
death in patients at high risk. In this article, the key are among the highest risk groups for having a
indications for implantation of an AICD are discussed recurrent cardiac arrest. Pivotal studies in patients
with the accompanying evidence based on which with aborted sudden cardiac death – AVID (2), CIDS
these indications have been made. and CASH proved the survival benefit with AICD
implantation in this subgroup of patients. Therefore
this remains one of the most important indications
Introduction:
for AICD implantation. Apart from patients with
Sudden Cardiac Death is an unexpected natural death cardiac arrest due to ventricular fibrillation, those with
of cardiac causes occurring within a short period of sustained ventricular tachycardia in the presence of
onset of symptoms. It is a major contributor to all structural heart disease are also considered for AICD
death and in India, has been estimated to account implantation for secondary prevention.
for about 10% of all deaths (1). When documented, the
rhythm is found to be ventricular fibrillation in these Thus secondary prevention is a class I indication
patients. Defibrillation is an effective for AICD implant except for one important caveat.
Most important is to exclude a reversible cause for
treatment for this rhythm, but most events occur the cardiac arrest in which case AICD implantation
outside a hospital setting and immediate access to is not required. This may occur, for example, in the
defibrillation is not available. following settings -

The Automatic Implantable 1. Ventricular fibrillation within 48 hours of acute
myocardial infarction (primary VF).
Cardioverter Defibrillator (AICD) is a miniaturised
defibrillator which can be implanted in a patient, can 2. Ventricular fibrillation in setting of hypokalemia
sense fibrillation and provide immediate cardioversion. or other electrolyte disturbances.
It represents an important technical advance in the 3. Ventricular arrhythmias in the setting of acute
management of these patients. However, the device myocarditis that resolves with treatment.
is costly, implantation is an invasive procedure and
complications can occur during implantation and
follow up. Therefore, identifying the right patient is

GCDC 2017