Implantable defibrillators for prevention of sudden death. Technology at a medical and economic crossroad.

Saksena, Sanjeev

doi:10.1161/01.cir.85.6.2316

Cited by 37 publications

(1 citation statement)

References 28 publications

(11 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The extent of benefit both with respect to cardiac mortality and total survival in this patient population remains to be accurately quantified, particularly vis-a-vis alternative antiarrhythmic therapies. Advanced device and lead systems can be expected to further improve both patient survival and quality of life after implant (76).…”

Section: Implantable Defibrillatorsmentioning

confidence: 99%

Orthoses and Prostheses

Hailey

1995

Int J Technol Assess Health Care

View full text Add to dashboard Cite

Orthoses and prostheses include a wide range of devices and strategies for correcting and alleviating dysfunction and disability. Features in these areas of technology include continuing evolution of new devices, further development of well-established approaches, a need for critical assessment, requirements for support from technical and health care workers, and the need to identify funding to achieve efficient programs.

show abstract

Section: Implantable Defibrillatorsmentioning

confidence: 99%

Orthoses and Prostheses

Hailey

1995

Int J Technol Assess Health Care

View full text Add to dashboard Cite

show abstract

The implantable defibrillator and antiarrhythmic drugs—competitive and complementary treatment for severe ventricular arrhythmia

Dorian

Newman

1993

Clinical Cardiology

View full text Add to dashboard Cite

Summary:Most patients with a history of sustained ventricular tachycardia (VT) or ventricular fibrillation (W) are at high risk of recurrence. Implanted defibrillators (ICDs) are highly effective in sensing and converting VT or VF to a perfusing rhythm. "Conventional" antiarrhythmic agents, which primarily block cardiac sodium channels, are relatively ineffective in preventing arrhythmia recurrence; amiodarone and sotalol appear to be effective in reducing recurrence and mortality rates, although the extent of benefit is not well understood. Despite the apparent advantage of ICDs, they have short-and long-term complications, are costly, and their benefit in prolonging the quantity or quality of life remains unproven. Randomized clinical trials which compare the effect of ICDs with that of antiarrhyhuc drugs on mortality, cost, and quality of life will be necessary to understand how patients with malignant arrhythmias ought to be treated. If an ICD is implanted, adjunctive therapies need to be considered to treat the underlying heart disease and to derive optimum benefit from the device. Drugs may have beneficial or adverse interactions with devices, and the full understanding of these interactions requires further study.Key wo& implanted cardioverter defibrillators, antiarrhythmic drugs, ventricular tachycardia The introduction and rapid technologic development of implanted cardioverter-defibrillators OCDs) have caused cardiologists with an interest in rhythm disoders to reevaluate the traditional premise on which antiarrhythmic thempy was basedthat of preventing the Occurrence or recurrence of life threatening ventricular arrhythmm, that is, sustained ventricular tachycardia 0 or ventricular fibrillation 0. It is widely accepted that patients surviving an episode of documented sustained VT, cardiac arrest, or syncope thought to be due to sustained tachyarrhythmia are at high risk of recurrence and of sudden cardiac death, especially in the first year after the initial event. The growing recognition that some antiarrhythrmc agents may not prevent malignant arrhythmias and may indeed increase their likelihood'. 2 has prompted some authorities to suggest that implanted defibrillators should be consided the therapy of choice for patients at risk for sudden death. Additional difficulties with the use of antiarrhythmic drugs include the inability to predict dmg efficacy reliably, even with the use of Holter monitoring or electrophysiologic study, and the risk of adverse effects from drug therapy.Although conceptually inelegant, since the lethal rhythm is not prevented, ICDs are 2 98% effective in diagnosing and converting VT or VF to a perfusiig rhydun (Fig. 1). Should the cardiologic community abandon the search for the "pharmacologic holy grail" in favor of ICDs for all or most patients with VT or VF? A brief review of the evidence in favor and against this approach may place this difficulty in pempective.Antiarrhythmic drug therapy guided by Holter monitoring or electrophysiologic testing (EPS)-although the relati...

show abstract

A. John Camm

Hurst

Fye

Lüderitz

2003

Clinical Cardiology

View full text Add to dashboard Cite

At the age of eighteen he entered London University, where he obtained his baccalaureate degree with a physiology major. He went on to study medicine at Guy's Hospital Medical School, receiving his M.D. in 1971. Afterwards, he worked at Guy's Hospital for three years under the tutelage of cardiologist Edgar Sowton, one of the greats of the early days of pacing. Dr. Camm was his hands in 1973 and did several hundred pacemakers by himself with the help of a radiographer and a nurse. After leaving Guy's Hospital, Dr. Camm spent a year in Burlington, Vermont. In the U.S., Dr. Camm worked with cardiologist Art Levy in the field of electrophysiology and with E. Lepeschkin, a famous electrocardiologist who had worked with Frank Wilson and had married his daughter, Julie Wilson. After his time in Vermont, Dr. Camm returned to London in 1975 to work at St. Bartholomew's Hospital, the oldest of the London hospitals, founded in 1123. At that time, Dr. R.A.E. Spurrell was in charge of St. Bartholomew's relatively small cardiac department. Dr. Spurrell had worked with Dr. Dirk Durrer and Dr. Hein J.J. Wellens as well as with several other pioneers in electrophysiology. Dr. Camm quickly rose in the ranks at St. Bartholomew's, eventually implementing electrophysiology services at the hospital. He assembled a team of very accomplished young physicians, including electrophysiologists David Ward and Antony Nathan. One of their research projects was the definition of the anatomical basis of Mahaim fibers; they were also one of the first groups involved in antitachycardia pacing.

show abstract

Implantable defibrillators for prevention of sudden death. Technology at a medical and economic crossroad.

Cited by 37 publications

References 28 publications

Orthoses and Prostheses

Orthoses and Prostheses

The implantable defibrillator and antiarrhythmic drugs—competitive and complementary treatment for severe ventricular arrhythmia

A. John Camm

Contact Info

Product

Resources

About