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Background : Since its introduction, the implantable cardioverter defibrillator (ICD) has evolved to its present status as the dominant therapeutic modality for patients with life-threatening arrhythmias. Several randomized studies have shown the benefit of ICD implantation as the first choice of treatment for primary as well as secondary indications for ventricular arrhythmias. Therefore, it is expected that the use of ICDs will increase further. The main objectives of this study were to analyze the Israeli experience with ICD implantation from 1993 to 1999, to examine the diffusion of ICD therapy in Israel and the evolution of implantation patterns and indications. Methods : We conducted a retrospective review and analysis of an ICD registry for the period of January 1993–December 1999. Data collected included demographic, administrative, clinical and survival data. Results : A total of 732 new implantations were identified and reviewed. The mean length of follow up of all patients was 30.7±21.1 months. 86% of patients were males and the mean age at implantation was 62.6±12.4 years. 79% of patients had CAD and the mean EF of all patients was 29.2±11.2%. 135 patients (18.4%) died during follow-up. One, two and three-year survival rates were calculated and were 92.7%, 87.8% and 82.0% respectively. A steady increase in implantation rate and in implanting centers was observed over the years. Conclusions : ICD therapy is relatively expensive; therefore a national registry which is continuously monitored may be the most expedient method to follow clinical and economic aspects of the utilization of this therapeutic modality.

Current clinical guidelines advocate implantable cardioverter defibrillator (ICD) therapy for the prevention of sudden cardiac death among post myocardial infarction (MI) patients. However, there are scarce data regarding compliance with the guidelines and utilization of this life-saving treatment. We aimed to assess the rate of ICD utilization among post MI patients with left ventricular ejection fraction (LVEF) ≤35%. Methods All patients admitted with a ST-elevation MI at a single tertiary care center from 2005 to 2009, discharged alive with LVEF≤35% and surviving 40days were included. Patients already implanted with an ICD and whose residence was outside the hospital's area of coverage were excluded. ICD utilization, LVEF re-assessment and mortality were assessed during mean follow up time of 2years. Results Of the 285 subjects, only 26 (9%) received an ICD. There were significant differences in ICD use among different medical health organizations (insurers). Among the 259 subjects not implanted with an ICD, repeat echocardiography study for the re-assessment of LVEF was performed in only 176 (68%). Of those, LVEF remained severely impaired in 47%. After excluding subject whose LVEF improved at follow up, the ICD utilization rate was 14%. In a multi-variable analysis, significant predictors of ICD utilization were age below the median of 61years, and a repeat echocardiography. Using propensity score and matching of subjects implanted with ICD with those not implanted, ICD implantation was found to be associated with survival benefit. Conclusions ICDs are underutilized in post MI patients and compliance with current guidelines is insufficient. Failure to re-assess LVEF is a barrier for this life-saving treatment. Withholding ICD therapy among unselected post MI patients with depressed LVEF is associated with a markedly increased mortality.

In the treatment of patients with suspected acute myocardial infarction, the use of thrombolytic therapy could be coined as ‘the race against time’, as rapid implementation of thrombolysis may save myocardial mass and decrease mortality. In cases having typical clinical presentations and ECG changes, a rapid and accurate therapeutic decision must be made. In patients with atypical clinical signs and ECG recordings, the chronologic urgency may force a decision concerning the use of thrombolysis while the diagnosis is uncertain. In these circumstances, thrombolytic therapy may be dangerous, particularly in cases of aortic dissection, pericarditis and gastrointestinal tract pathology. Gastrointestinal disorders presenting with epigastric pain are an important part of the differential diagnosis of myocardial infarction. In this situation, the ECG

We describe an unusual case of transient complete atrioventricular block induced by a chest thump during resuscitation in a patient with ventricular tachycardia.