[Prevention of sudden cardiac death by the implantable cardioverter defibrilator].

INTRODUCTION; Sudden cardiac death or, as it is also called, a modern man's killer occurs a few hours after the beginning of the disease. Sudden death is the one that happens within an hour from the onset of the subjective discomforts regardless of the existence of any previous disease. According to modern statistics, 450.000 people die suddenly in the USA and 150,000 in Germany. CAUSES OF SUDDEN DEATH: The most frequent causes of sudden death are cardiologic or, in other words, a heart rhythm disorder such as ventricular tachycardia, ventricular fibrillation and bradycardiac rhythm disorder. All these reasons can be efficiently prevented by the implantation of the cardioverter defibrillators. IMPLANTABLE CARDIOVERTER DEFIBRILLATOR: In comparison with the already known medications, the defibrillator seems to be the most efficient in prevention of sudden cardiac death. This fact has been confirmed by large multicentre studies. The implantation itself is a routine procedure. It lasts about an hour and it often passes without any complications. The patient leaves the hospital a few days after the procedure. About 150 of these procedures are performed per year at the Institute of Cardiovascular Diseases Vojvodina. The Social Insurance Fund bears medical costs and the patient only pays the participation fee, which is symbolical if compared to the value and use of the device. Owing to this fact, this device is available to every patient thus making the efficient sudden cardiac death prevention possible.

[Modern pacemaker therapy].

INTRODUCTION: Pacemakers are devices that modern medicine and cardiology cannot be imagined without. The technique of implantation comes to surgical procedure where all principles of asepsis and antisepsis have to be respected. Although some complications do happen, the)y are rather rare. RESULTS: After the implantation of the device, the patient is not handicapped (unless the heart was additionally damaged). On the contrary, the patient returns to his work and functions normally within his family in most of the cases. The first medical appointment is scheduled a month after the implantation and the following are three and six months after. TYPES OF DEVICES: Today there are "new types of electrostimulation"--implantable cardioverter defibrillators and multisite electrostimulators. The former is implanted in patients at high risk of sudden cardiac death and the latter in patients with heart failure and left bundle branch block. Owing to these devices, the sudden cardiac death can be prevented successfully and the quality of a patient's life is improved.

[Ventricular fibrillation after surgical revascularization]. / Fibrilacija komora nakon hirurske revaskularizacije.

INTRODUCTION: Ventricular fibrillation (VF) presents a complete disintegrated myocardial activity associated with hemodynamic collapse and loss of consciousness requiring urgent reanimation. VF mostly occurs following myocardial infarction and endstage of ischemic heart disease in patients with ejection fraction less than 30%. MATERIAL AND METHODS: This paper analyzes occurrence of VF following coronary artery revascularization in patients undergoing surgery at the Institute of Cardiovascular Diseases in Sremska Kamenica. During the period 1994-1998, 3.186 patients underwent coronary artery revascularization procedure, whereas following it VF occurred in 20 patients (0.63%). RESULTS AND DISCUSSION: In all patients VF presented in the first postoperative week, while in 16 patients it occurred in the first 3 days following surgery. Nine patients with VF underwent left coronary artery revascularization with endarterectomy, 9 patients underwent right coronary artery revascularization with endarterectomy. One patient had a left-ventricular aneurysmectomy and 80% of patients had low ejection fraction rate--20-35%. After VF in 75% of patients urgent reoperation was performed, and only one suffered from thrombotic occlusion, that is perioerative infarction. After defibrillation patients were treated with xylocaine, amiodarone and beta-blockers. During the 30-day period following surgery, there were no lethal outcomes, whereas in the 24-month period after surgery 3 patients died. Cardiac-related death occurred in one patient, while two died due to cerebral insult. CONCLUSION: VF was not a frequent complication in our patients. Effective antiarrhythmic drugs prevent repeated VF. Beta-blockers, xy-locaine and amiodarone are drugs of choice for the treatment of malignant cardiac rhythm disturbances.