Background. Using implantable cardioverter-defibrillators in treatment of malignant ventricular arrhythmias
revealed new complications specific to this therapy. Inappropriate therapy, arrhythmic storm and device related
proarrhythmia belong to the most significant complications. The authors describe specific complications in a group
of ICD patients, analyze their etiology and prognostic value. There are some recommendations for the management
of specific complications.
Methods and Results. 138 consecutive patients underwent ICD implantation between 1994-2001. Median follow-up
was 47,35 months.Average left ventricular ejection fractionwas 38±14%and 71%of patients suffered from coronary
artery disease. From the total of 2490 arrhythmic episodes 1490 were evaluated in detail. 253 episodes (17 %) were
classified as inappropriate therapy. The most common etiology of inappropriate therapy was atrial fibrillation with
rapid ventricular response (68%), atrial flutter (13%) and sinus tachycardia (11%). After the therapeutic intervention,
65 % of them remained free of inappropriate therapy. There were 38 arrhythmic storms in 19 patients as another
Conclusions. All the observed arrhythmic episodes were ventricular tachycardias (p<0.04). Patients with arrhythmic
storm in history had significantly lower survival (p<0,05). The risk factors of cardiac nonsudden death were:a ge
>66 years, left ventricular ejection fraction <35 % and arrhythmic storm history. The authors present recommendations
for the treatment of the most common specific ICD complications.
implantable cardioverter-defibrillators, inappropriate therapy, arrhythmic storm, proarrhythmia.