Internal Defibrillator Shock May Be Avoidable
Internal Defibrillator Shock May Be Avoidable
Milder Device, With ICD as Back-Up, Just as Effective for Life-Threatening Fast Heartbeat
Oct. 18, 2004 -- Mild electrical pulses -- rather than more powerful and painful shocks -- can keep life-threatening rapid heartbeats under control, new research shows. It's an important quality-of-life issue for people with internal defibrillators.
When internal defibrillators (also called implantable cardiac defibrillators or ICDs for short) were first developed, the device was heralded as a lifesaver. By sending powerful shocks to the heart, an ICD interrupts the dangerously rapid heartbeat called ventricular tachycardia, and restores a normal heart rhythm. Left untreated, ventricular tachycardia can lead to death.
While most people who got internal defibrillators tolerated them just fine, many others reported significant anxiety and depression due to the painful shocks, writes researcher Mark S. Wathen, MD, with Vanderbilt University Medical Center in Nashville, Tenn. His paper appears in the latest issue of the journal Circulation: Journal of the American Heart Association.
Another device called antitachycardia pacing (ATP) has since been developed to short-circuit less-ominous heartbeat irregularities, and delivers a milder electrical pulse than an ICD shock, writes Wathen. However, recent studies have shown that the ATP also works in controlling the more serious rapid heartbeat problems, such as ventricular tachycardia or ventricular fibrillation, too.
This newest study is the first head-to-head comparison of quality of life for both ATP and ICD patients.
"ATP is safe and effective compared with shocks [from internal defibrillators]" in stabilizing rapid heartbeat, writes Wathen.
In his study, Wathen recruited 634 patients with ICDs, half of whom were randomly assigned to have initial treatment with ATP for 11 months. The ATPs were programmed to detect the dangerous ventricular heartbeat problems; if the ATP failed to work, the ICD acted as a back-up. The ICD-only group received the standard stock when one of these deadly arrhythmias occurred.
He found that ATP "treated" 73% of the deadly ventricular arrhythmias, with no difference in "episode duration" -- length of the heartbeat problem -- and no difference in death rate, compared with the ICD.
Importantly, ventricular tachycardia made up 76% of all heartbeat irregularities that would have been treated with ICDs, he notes.
Patients completed a quality-of-life questionnaire before the study began and after it ended.
Those results:
Wathen and his research group "recommend ATP as the preferred therapy" for people at risk for ventricular arrhythmias, including those who currently have an internal defibrillator.
Internal Defibrillator Shock May Be Avoidable
Milder Device, With ICD as Back-Up, Just as Effective for Life-Threatening Fast Heartbeat
Oct. 18, 2004 -- Mild electrical pulses -- rather than more powerful and painful shocks -- can keep life-threatening rapid heartbeats under control, new research shows. It's an important quality-of-life issue for people with internal defibrillators.
When internal defibrillators (also called implantable cardiac defibrillators or ICDs for short) were first developed, the device was heralded as a lifesaver. By sending powerful shocks to the heart, an ICD interrupts the dangerously rapid heartbeat called ventricular tachycardia, and restores a normal heart rhythm. Left untreated, ventricular tachycardia can lead to death.
While most people who got internal defibrillators tolerated them just fine, many others reported significant anxiety and depression due to the painful shocks, writes researcher Mark S. Wathen, MD, with Vanderbilt University Medical Center in Nashville, Tenn. His paper appears in the latest issue of the journal Circulation: Journal of the American Heart Association.
Another device called antitachycardia pacing (ATP) has since been developed to short-circuit less-ominous heartbeat irregularities, and delivers a milder electrical pulse than an ICD shock, writes Wathen. However, recent studies have shown that the ATP also works in controlling the more serious rapid heartbeat problems, such as ventricular tachycardia or ventricular fibrillation, too.
This newest study is the first head-to-head comparison of quality of life for both ATP and ICD patients.
"ATP is safe and effective compared with shocks [from internal defibrillators]" in stabilizing rapid heartbeat, writes Wathen.
Rapid Heartbeat Benefits From Milder Shock
In his study, Wathen recruited 634 patients with ICDs, half of whom were randomly assigned to have initial treatment with ATP for 11 months. The ATPs were programmed to detect the dangerous ventricular heartbeat problems; if the ATP failed to work, the ICD acted as a back-up. The ICD-only group received the standard stock when one of these deadly arrhythmias occurred.
He found that ATP "treated" 73% of the deadly ventricular arrhythmias, with no difference in "episode duration" -- length of the heartbeat problem -- and no difference in death rate, compared with the ICD.
Importantly, ventricular tachycardia made up 76% of all heartbeat irregularities that would have been treated with ICDs, he notes.
Patients completed a quality-of-life questionnaire before the study began and after it ended.
Those results:
- The shock group had improvement in bodily pain only.
- The ATP group had significant improvement in physical functioning, bodily pain, social function, and overall mental and physical status.
Wathen and his research group "recommend ATP as the preferred therapy" for people at risk for ventricular arrhythmias, including those who currently have an internal defibrillator.
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