PHƯƠNG PHÁP ĐIỀU TRỊ PHÁ RUNG (ICD) Ở BỆNH NHÂN: KINH NGHIỆM DÀI HẠN TỪ MỘT TRUNG TÂM

Abstract

Background: The implantable cardioverter-defibrillator (ICD) is the most effective method for preventing sudden cardiac death (SCD) in patients with Brugada syndrome (BrS), a dangerous genetic disorder with a high risk of life-threatening arrhythmias. However, the decision to implant an ICD and the management of BrS patients face significant challenges due to individual risk factors and post-procedure complications. Objective:This study was conducted to evaluate the efficacy and safety of ICD in Vietnam, a region with a high prevalence of BrS. Method: Retrospective cohort study. Result: A total of 186 BrS patients treated at Cho Ray Hospital from 2018 to 2023 were included in the study. The majority were male (93%) with a mean age of 45,7 ± 12,1 years. Of these, 96,7% received single-chamber ICDs, and the implantation procedure was performed safely with no major complications reported. The average procedure time was 51,2 ± 31,5 minutes, demonstrating an effective and safe intervention. Implantation parameters such as pacing thresholds and impedance were within normal limits, ensuring proper device function. During a mean follow-up period of 34,2 ± 14,5 months, 4,3% of patients experienced ventricular fibrillation, all of which were successfully managed with ICD shocks. Additionally, other arrhythmias such as atrial fibrillation and ventricular tachycardia were observed at lower rates. Notably, patients with a history of out-of-hospital cardiac arrest (OHCA) had a significantly higher risk of serious arrhythmic events, with an odds ratio (OR) of 42 and a 95% confidence interval (CI) ranging from 5,22 to 422,85. Conclusion: The study confirms that ICD therapy is a safe and effective method for preventing SCD in BrS patients, particularly those at high risk. The low complication rate and high treatment efficacy highlight the importance of ICD implantation and these findings provide essential scientific evidence for improving treatment strategies and developing appropriate clinical guidelines, especially in regions with a high prevalence of BrS, such as Vietnam.