Indications for implantable cardiac defibrillators and complications of permanent pacing
THE CONTEXT
Implantable cardiac defibrillator indications are divided into primary and secondary prevention. The passage also lists early and late complications of permanent pacing.
Primary prevention indications
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After myocardial infarction, a left ventricular ejection fraction below 30% is an indication.
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Mild to moderate symptomatic heart failure despite optimal drug therapy is an indication when the left ventricular ejection fraction is below 35%.
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Some patients with inherited cardiac conditions, including long QT syndrome and cardiomyopathy, are candidates.
Secondary prevention indications
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Survivors of ventricular fibrillation or ventricular tachycardia cardiac arrest are candidates when the arrest has no transient or reversible cause.
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Ventricular tachycardia with haemodynamic compromise or significant left ventricular impairment, defined here as an ejection fraction below 35%, is an indication.
Complications of permanent pacing
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Early complications include pneumothorax, cardiac tamponade, infection and lead displacement.
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Late complications include infection, erosion of the generator or lead, chronic implant-site pain and lead fracture due to mechanical fatigue.
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Late infection usually requires extraction of the pacing system.