| Abstract [eng] |
Nowadays the burden of cardiovascular diseases continues to increase globally. Such diseases like heart failure, myocardial infarction and atrial fibrillation put a person in a greater risk for each of these conditions. This thesis presents a sixty year-old patient who was diagnosed with a permanent atrial fibrillation and a coronary heart disease. Additionally, he has survived a ventricular fibrillation. Currently he came for a biventricular cardioverter-defibrillator generator change procedure. Also this thesis will discuss the relevance of sudden cardiac death and its prevention methods, particularly implantable cardioverter-defibrillator. According to different studies, implantable cardioverter-defibrillator does decrease the mortality in heart failure patients, although the data gathered by DANISH trial was ambigual. The rate of inappropriate shock generated by implantable cardioverter-defibrillator was reported to be as high as 13% to 17%. In addition to that, it was associated with an 2 to 5-fold increased mortality risk. The most common cause of inappropriate shock was atrial fibrillation. According to one retrospective analysis from MADIT-CRT, carvedilol has significantly reduced the risk of inappropriate shock in comparison to metoprolol. Catheter ablation should also be considered in patients with implantable cardioverter-defibrillators. Cardiac resynchronisation therapy improves cardiac function, symptoms, well-being and reduces morbidity and mortality in an appropriately selected group of heart failure patients. Present CRT recommendations are applicable to all patients in NYHA functional class II-IV of any aetiology, QRS >130 ms and in sinus rhythm, less frequently in atrial fibrillation. Approximately 50% of patients, who undergo a device implantation, require an antithrombotic therapy, which can cause a pocket haematoma or infection. |
