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I have had chronic nonsubstained VTs for 7 years....an
Sent to Health Experts May 22 09:56 AM

I have had chronic nonsubstained VTs for 7 years....an Ejection fraction 35 to 40.....lipids under control with very mild CAD.....68 years old...no symptions from VTs...borderline candidate for a defibrillator...can you give me info such as odds with and without def?   Thanks, Nelson Lowe

 

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only annual echos and stress tests and coreg, accupril, and zocor

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May 22 10:46 AM (49 minutes and 28 seconds later)
         
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I understand your concern. It sounds like you have nonsustainted VT with a reduced ejection fraction. Some trials showed that without implantation of an Implantable Cardiac Defibrillator (ICD), the mortality rate within two years is reported to be higher than 30 percent in patients with nonsustained ventricular tachycardia on Holter monitoring and impaired left ventricular function. So I believe this applies to you. Two large multicenter trials showed a clear advantage for ICD implantation over drug therapy in patients with an arrythmia like this.

Implantable defibrillators appear to be most beneficial in patients like you, with a low ejection fraction and nonsustained ventricular tachycardia on Holter monitoring, and a history of syncope or near-syncope.

Perioperative complications are rare, and most patients benefit tremendously from ICD placement. Nevertheless, complications include exacerbation of VT, postoperative atrial fibrillation and complications relating to lead placement, including cardiac perforation.

With this being said, this is a decision that you need to run by your cariologist in detail. Your case is unique, and since you are asymptomatic, you both might place a different value on an ICD. Studies can help you to make the decision, but you should really sit down with your physician, and go through the numbers. He/she might know of another factor in your history that changes these numbers in some way. So run it by them before you make the choice.

I hope this helps. Please let me know if you have any further questions. Take care.

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Jonathan Fay, M.D. -- Doctor (MD) -- 100% Positive Feedback on 534 Health Accepts
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May 22 10:58 AM (11 minutes and 57 seconds later)
         
Reply to Jon Fay's Post: Do you know of any statistics on complications arising from the implanting of a Def. ?
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May 22 11:10 AM (12 minutes and 34 seconds later)
         
Reply to Jon Fay's Post: One more thought and I certainly will make payment(don't think for a minute I would be that unprofessional) I have had this for 7 years and done strenuous work during this period without any symptoms from the VT including any dizziness, pain etc and wore a king of hearts monitor for one month which alerted me when I was having VT and asked if I was experiencing any pain which I was not. My cardio doctor says I am borderline for a Def. and my family physician is cool on such an implant. Thanks, it is nice to have someone to discuss this with. Nelson
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May 22 11:23 AM (13 minutes and 17 seconds later)
         
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The numbers that I found on mortality were through an American College of Cardiology Practice Guideline (published in 2002, so thinking amongst cardiologists has probably shifted a bit since then); at least it will give you a general idea. If the device is implanted, as many as these days, without having to open the chest (transvenously), the procedure mortality rate is 0.5-0.8%.

Complications include hematoma formation (a blood collection at the site of implantation), infection, fracture of the leads to the device, or are related to an improperly adjusted device. This occurs in approx. 10% of patients, but this can vary substantially according to the type of device used and the practictioner. In addition, only some of these complications require substantial revision (like lead fracture), whereas others (like hematoma) are less problematic.

I hope this helps. Below are two of the links that I found most informative. Take a look and see what you think.

http://www.acc.org/clinical/guidelines/pacemaker/pacemaker.pdf
http://www.medscape.com/viewarticle/504457

Again, let me know if you have any more questions. I know it's a big decision and if I was having it done I would also be looking at these numbers. But remember to discuss this with your physician as well. Take care.

EDIT: your last post was posted while I was writing. If you are borderline, as your cardiologist calls it, then from their standpoint it sounds like it is a toss-up. For many implantation of an ICD is a "no-brainer", as the risk of death (not to mention symptoms) is substantial versus the benefits. I think you should really speak with your cardiologist, and even a few patients of his/hers who have had them implanted, and ask what their experiences have been like - good, bad? While it is easy to look at a percentage or a number, when someone tells you what it can be like to really live with something, I think that is sometimes more valuable. Sometimes, people wouldn't do it again, and others wouldn't think twice about repeating it. It just depends on who you identify more with.

Hope this helps, and take care.

Edited by jcfay on May 22 2006 at 11:28 AM

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Jonathan Fay, M.D. -- Doctor (MD) -- 100% Positive Feedback on 534 Health Accepts
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May 22 12:24 PM (1 hour and 53 seconds later)
         
Reply to Jon Fay's Post: I ususllly pay by Paypal, Let me know if it processes. Thanks again
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May 22 3:07 PM (2 hours and 42 minutes and 30 seconds later)
         
it did go through. Thanks for your business. If you wish, you can request me for further questions. I would be happy to oblige. Take care. (I listed this as an "info request" so no need to click accept again)

If I have helped, then please click the ACCEPT button and leave positive feedback - Thank you, and take care
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Jonathan Fay, M.D. -- Doctor (MD) -- 100% Positive Feedback on 534 Health Accepts
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