Objective: To report appropriate (AT) and inappropriate (IT) ICD therapies in patients with ischemic and nonischemic heart disease, as well as early and late procedure-related complications. Methods:One hundred and fifty-five patients (119 male and 36 female), mean age 47 years (21-88), who underwent ICD implantation between 1994 and March 2003 were analyzed. Patients were divided into the following groups: Group I -Post-AMI patients (n = 80); Group II -Patients with nonischemic heart disease and LV ejection fraction < 40% (n = 45), Chagas disease (n = 18), idiopathic dilated cardiomyopathy (n= 12), hypertensive disease (n = 8), hypertrophic cardiomyopathy (n = 4) and valvular heart disease (n = 3); Group III -Patients with arrhythmogenic right ventricular dysplasia (n = 13); and Group IV -Patients with channelopathies: Brugada Syndrome (n = 8) and idiopathic ventricular arrhythmias (n = 9). All patients underwent EPS before ICD implantation.Results: During the 26-month mean follow up, a high rate of appropriate ICD therapies (antitachycardia pacing and/or shock) was observed (46%) in the four groups, with no statistically significant difference. The four groups did not differ in either overall (8.4%) or arrhythmic mortality (1.3%). There was no correlation between appropriate ICD therapies and initial clinical presentation or inducible ventricular arrhythmia at EPS, and a 4% incidence of early and late procedure-related complications was found. Conclusion:The high incidence of appropriate ICD therapy and low rate of sudden death in the patients studied suggest that ICD is a valuable strategy in the management of ischemic and nonischemic patients previously selected by means of EPS.Key words: Sudden death, implantable cardioverter-defibrillator, appropriate and inappropriate discharges, ischemic and nonischemic heart disease.
Brazilian citizens and its public health system have been dealing with Aedes aegypti and dengue for more than a decade now. More recently, Zika and Chikungunya (CHIKV) viruses have arisen, sharing the same vector as dengue. Some reports initially suggested that those new arbovirosis had a better prognosis, but specially (CHIKV) infection is such a young variation of dengue that researches worldwide still need more time to understand its behaviour. The population previously exposed to the virus together with climatic changes and inadequate sanitary situation were favorable for an outbreak and then a decrease in clinical cases in Brazil. CHIKV infection can present with an acute/ subacute phase followed by a chronic condition. The acute phase has shown severe atypical manifestations mainly in people with comorbidities, increasing the risk of death. The objective of this case report is to describe the sudden and unexpected deaths of two young and healthy females presumed caused by CHIKV in a 24-hour period after admission to a Public Heath Hospital in Rio de Janeiro, Brazil. On this behalf, this more recent arbovirus infection still represents a great challenge to emergency care physicians and researchers worldwide and it seems too early to determine CHIKV acute and late prognosis. Science should be aware that CHIKV outbreak emerge as lethal as dengue or even worse.
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