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      Desfibrilador implantable en el manejo de taquiarritmias ventriculares malignas: Experiencia del Centro Nacional de Arritmias Translated title: Implantable defibrillators in the management of malignant ventricular tachyarrhythmias

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          Background: Implantable defibrillators are the most effective means to prevent sudden death in patients with malignant ventricular tachyarrhythmias. The availability of this type of devices is limited in Chile, due to their high price. Aim: To report the first patients treated with implantable defibrillators in our hospital. Patients and methods: Nine males and one female aged 13 to 65 years old are reported. Three presented with ventricular fibrillation (presenting out of the hospital in three) and the rest had ventricular tachycardia resistant to drugs or radiofrequency ablation. Results: All implants were performed using intracardiac electrodes. The generator was implanted in the pectoral region in nine and in the abdomen in one. A successful defibrillation was obtained with less than 15 J in four patients, with 20 J in three and with 24 J in three. There were no complications during the procedure. After a 12 months follow up, four patients have been treated by the implantable device. One of these subjects had a ventricular fibrillation in two occasions. One patient died of a bronchopneumonia two years after the implant. Conclusions: Implantable defibrillators are an effective therapy for the treatment of malignant ventricular arrhythmias with a high risk of sudden death.

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          Most cited references36

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          Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings.

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            A Comparison of Antiarrhythmic Drug Therapy with Implantable Defibrillators in Patients Resuscitated from Near-fatal Ventricular Arrhythmias

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              Further characterization of the syndrome of right bundle branch block, ST segment elevation, and sudden cardiac death.

              We recently described a syndrome characterized by an ECG pattern of right bundle branch block and persistent ST segment elevation in leads V1 to V3 in patients suffering from aborted sudden cardiac death and not having demonstrable structural heart disease. We present new observations on this syndrome, especially those related to asymptomatic and intermittent forms. Forty-seven patients with the described ECG pattern were identified; 32 were symptomatic with syncope and sudden death aborted by cardiopulmonary resuscitation. Eleven patients received pharmacologic therapy, mainly amiodarone and/or beta-blocking agents, and 21 patients received an implantable defibrillator with or without pharmacologic therapy. Three of the 11 patients on pharmacologic therapy died suddenly during follow-up, while 9 of 21 patients with an implantable defibrillator used the device during follow-up. The remaining 15 patients were asymptomatic when first seen. Three patients died suddenly after 6 years, 3 months, and 2 months of follow-up without treatment. Another patient received an implantable defibrillator after syncope and had subsequent episodes of ventricular fibrillation terminated by the defibrillator. The other 11 patients remain asymptomatic without (6) or with (5) treatment with beta blockers. In 14 of the 47 patients, the ECG normalized momentarily during follow-up but later became abnormal again. During transient normalization of the ECG, administration of ajmaline or procainamide unmasked the described ECG pattern in six patients who received the drug. Long-term follow-up of survivors failed to show progression to any form of right or left ventricular cardiomyopathy.
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                Author and article information

                Journal
                rmc
                Revista médica de Chile
                Rev. méd. Chile
                Sociedad Médica de Santiago (Santiago, , Chile )
                0034-9887
                July 1998
                : 126
                : 7
                : 803-813
                Article
                S0034-98871998000700008 S0034-9887(98)12600708
                10.4067/S0034-98871998000700008
                8dc704d7-9268-44b9-9e8a-40c94d52e997

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 29 December 1997
                : 05 March 1997
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 24, Pages: 11
                Product

                SciELO Chile

                Categories
                EXPERIENCIAS CLINICAS

                Ventricular fibrillation,Arrhythmia,Defibrillators, implantable,Tachycardia, ventricular

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