ICD Devices May Save Enlarged Hearts

Heart
devices called implantable cardioverter defibrillators (ICDs) may help protect
people with enlarged hearts from sudden cardiac death, a new study shows.

The study focuses on a genetic condition called hypertrophic c ardiomyopathy (enlarged heart
due to thickened heart
muscle ).

ICDs are surgically implanted devices that are designed to note abnormal
heart rhythms and deliver an electrical shock to make hearts beat properly.

Hypertrophic cardiomyopathyB accounts for most cases of sudden cardiac
death in young people, including trained athletes, write the researchers, who
included Barry Maron, MD, of the Minneapolis Heart Institute Foundation.

Maron's team reviewed data on 506 people with enlarged hearts who got ICDs
between 1986 and 2003 in the U.S., Australia, and Europe.

The patients were 42 years old, on average, when they got their ICDs. Nearly
90% of them had "no or only mildly limiting symptoms," write Maron and
colleagues in The Journal of the American Medical Association.

ICDs and Enlarged Hearts

The researchers followed the patients for nearly four years, on average.
During that time, the ICDs appropriately stopped dangerous heart rhythms in 20%
of the patients.

The chance of that happening was roughly the same for patients with one,
two, or three risk factors for sudden death.

However, ICDs fired inappropriately in 102 patients over the years, and one patient (who turned out to have
a defective ICD) died as a result.

Other risks included infection, bleeding or clotting, and problems with the
ICD.

Maron's team concludes that ICDs may help prevent sudden cardiac death in
people with hypertrophic cardiomyopathyB who have only one risk factor for
sudden cardiac death.

But the researchers stress that "it is not our intention to promote a
strategy for universal ICD implantation in patients with hypertrophic
cardiomyopathy who have only one risk factor."

The study was funded in part by Medtronic, which makes ICDs. Two of the
researchers (but not Maron) report financial ties to Medtronic and other ICD
companies.

ICDs and Enlarged Hearts: Second Opinion

ICDs should "definitely" be considered by patients with hypertrophic
cardiomyopathyB who have already had a heart attack or sustained fast
heartbeats, states an editorial published with the study in The Journal of
the American Medical Association.

ICDs are likely warranted in patients with enlarged hearts who have two or
more risk factors for sudden cardiac death, according to editorialists Rick
Nishimura, MD, and Steve Ommen, MD, who work in the division of cardiovascular
diseases and internal medicine at the Mayo Clinic College of Medicine in
Rochester, Minn.

"However," the editorialistsB write, "the decision to
implant an ICD in any patient, especially one with a single risk factor, must
include a thorough and earnest discussion" of risks and benefits, as well
as the patient's views on "procedures, devices, and death."

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By Miranda Hitti
Reviewed by Louise Chang
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