Aktivacija i vrste aktivacija implantabilnog kardioverter defibrilatora u korelaciji s kliničkim parametrima

master's thesis

• Title (english): Activation and types of activation of implantable cardioverter defibrillators in correlation with clinical parameters
• Author: Nikola Verunica
• Mentor: Tomislav Letilović (mentor)
• Committee member: Slobodanka Ostojić-Kolonić (predsjednik povjerenstva)
• Committee member: Martina Lovrić Benčić (član povjerenstva)
• Committee member: Tomislav Letilović (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2019-07-12, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

ICD terapija je prošla izvanredanu transformaciju u 25 godina otkad je uređaj
odobren za ljudsku upotrebu. Moderni uređaji pružaju detaljne informacije o
frekvenciji i morfologiji elektrokardiografskih signala prije, tijekom i nakon terapije.
Jednostavnost implantacije defibrilatora sada se približava onoj od pacemakera,
zbog smanjenja pulsnog generatora i poboljšanja dizajna odvoda i valnih oblika
šoka. Unatoč poboljšanju dijagnostičkih mogućnosti i redukcije u veličini,
dugovječnost uređaja je sada >6 godina. Daljnje napredovanje u tehnologiji
odvoda i algoritmima diskriminacije aritmija morale bi povećati efikasnost i
pouzdanost terapije. Naposljetku, uređaj ima sposobnosti tretiranja multiplih
problema u dodatku životno ugrožavajuće ventrikularne aritmije, i atrijalne aritmije
i CHF.
U ovoj studiji retrospektivno smo evaluirali pacijente kojima je uređaj ugrađen u
vremenskom periodu od 1.1.2013-1.1.2019. godine na odjelu Kardiologije KB
Merkur. U studiju je uključeno ukupno 91 pacijenata, 11 (12%) žena, i 80
muškaraca (88%). Cilj ove studije je bio usporediti aktivaciju ICD/CRT-D uređaja
u usporedbi sa kliničkim parametrima koje smo odabrali kao bitne. Kliničkim
parametrima koje smo odabrali smo pokrili etiologiju bolesti, komorbiditete koji su
bitni i medikamentoznu terapiju. Klinički parametri su redom bili: ICM, NICM, SH,
HLP, DM, ASK, statini, β-blokatori, amiodaron, sakubitril/valsartan,
spironolakton/eplerenon i ARB/ACI. Ovi parametri su odabrani zbog njihovog
očekivanog učinka na aktivaciju uređaja koja proizlazi iz njihovog bilo
proaritmijskog ili antiaritmijskog učinka. Obradom dobivenih podataka za svaku
varijablu ponaosob nismo dobili statistički značajnu vrijednost. Rezultate ovog istraživanja treba uzeti sa rezervom zbog malog uzorka pacijenata, daljnjim
uključivanjem pacijenata kojima će uređaj biti ugrađen u narednim godinama u
KB Merkur ne možemo isključiti drukčiji ishod proširenog istraživanja.

Abstract (english)

ICD therapy has undergone remarkable transformation in 25 years since the device
was approved for human use. Modern devices provide detailed information on
frequency and morphology of electrocardiographic signals before, during and after
therapy. The simplicity of the defibrillator implantation is now approaching the
pacemaker, reducing the pulse generator and improving drain design and waveform
shapes. Despite the improvement of diagnostic capabilities and reduction in size, the
device's longevity is now> 6 years. Further advancement in drain technology and
algorithms of arrhythmia discrimination should increase the efficiency and reliability
of the therapy. Ultimately, the device has the ability to treat multiple problems in
addition to life-threatening ventricular arrhythmia, atrial arrhythmia and CHF.
In this study we retrospectively evaluated the patients whose device was built in the
period from 1.1.2013-1.1.2019. year at the Department of Cardiology KB Merkur.
The study included a total of 91 patients, 11 (12%) women, and 80 males (88%). The
aim of this study was to compare the activation of ICD/CRT-D devices compared to
the clinical parameters we chose as essential. The clinical parameters we chose
have covered the etiology of the disease, the comorbidities that are essential and the
medication therapy. Clinical parameters were in turn: ICM, NICM, AH, HLP, DM,
ASK, statins, β-blockers, amiodarone, sakubitril/valsartan, spironolactone/eplerenone and ARB/ACI. These parameters were selected because
of their expected effect on the activation of the device resulting from their either
proarrhythmic or antiarrhythmic effect. We did not get a statistically significant value
by processing data obtained for each variable. The results of this research should be
taken with the reserve due to a small sample of patients, further involvement of
patients with which the device will be installed in the following years in KB Merkur
can't rule out a different outcome of the extended research.

• Keywords: ICD; maligne aritmije; AH; HLP; DM; ICM; NICM; ASK; β-blokator; statini; ACI/ARB; amiodaron; spironolakton/eplerenon; sakubitril/valsartan
• Keywords (english): ICD; malignant arrhythmias; AH; HLP; DM; ICM; NICM; ASK; β-blocker; statins; ACI/ARB; amiodaron; spironolakton/eplerenon; sakubitril/valsartan
• Language: croatian
• URN:NBN: urn:nbn:hr:105:524728
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-10-31 10:23:27