Primary prevention of SCD using ICD- Review of literature

Primary prevention of SCD using ICD- Review of literatureDr Frijo Jose A

Risk stratication for ICD therapyIncidence of SCD in unselected adult population- only 2 per 1000 p/yrCurrently, LVEF- 1 factor to select pts for ICDSAECG, baseline V arrhythmia, T alternans, autonomic function, EPNon-invasive evaluation for SCDCardiovascular functionh/o syncopeVentricular arrhythmiasECGAutonomic function evaluationSerum markersInvasive evaluation of SCDEPS

Cardiovascular functionLVEF- most consistent & powerful predictor of all-cause & cardiac mortality in IHD & DCMPNYHA- Despite subjective, imprecise- simple bedside potent risk-stratification tool Degree of NYHA class- Not linearly related NYHA classes II & III - much more likely arrhythmia than class IV

Pts with NYHA IV CCF- very mortality from progressive pump failure Therefore, such pts not usually considered appropriate candidates for ICD therapyPrimary prevention ICD trials have excluded pts with NYHA IVPts with syncope have high risk of SCAIn CCF pts with a h/o syncope- incidence of SCD - 45%, V/S incidence 12% in pts with no h/o syncope (p