Circulation, Vol 85, 1304-1310, Copyright © 1992 by American Heart Association
SG Kim, JD Fisher, CW Choue, J Gross, J Roth, KJ Ferrick, R Brodman and S Furman
BACKGROUND. The outcomes of patients treated with implantable
defibrillators were compared between patients with left ventricular
ejection fraction greater than or equal to 30% and less than 30%. METHODS
AND RESULTS. Of 68 consecutive patients treated with implantable
defibrillators, 40 patients (group 1) had left ventricular ejection
fraction greater than or equal to 30%, and 28 patients (group 2) had left
ventricular ejection fraction less than 30%. Sudden death, surgical
mortality, nonsudden arrhythmia-related death (death within 24 hours after
an arrhythmic event despite initial termination of the arrhythmia by the
implantable defibrillator), total arrhythmia-related death (including
sudden death, surgical death, and nonsudden arrhythmia- related death), and
total cardiac death were compared between the two groups. Surgical
mortality was 4.4% (0% in group 1, 11% in group 2). During the follow-up of
31 +/- 27 months, actuarial survival rates free of events were 97%, 97%,
and 97% in group 1 and 96%, 91%, and 82% in group 2 at 12, 24, and 36
months, respectively, for sudden death (p = NS); 97%, 97%, and 97% in group
1 and 85%, 81%, and 72% in group 2 at 12, 24, and 36 months, respectively,
for sudden death and surgical mortality (p less than 0.05); 97%, 97%, and
97% in group 1 and 82%, 78%, and 70% in group 2 at 12, 24, and 36 months,
respectively, for total arrhythmia-related death (p less than 0.05); and
95%, 95%, and 95% in group 1 and 82%, 69%, and 57% in group 2 at 12, 24,
and 36 months, respectively, for total cardiac death (p less than 0.05).
Four (57%) of seven nonsudden cardiac deaths during the initial 36-month
follow-up period were causally related to arrhythmia (three surgical deaths
and one arrhythmia-related nonsudden death). CONCLUSIONS. The outcome of
patients treated with implantable defibrillators is strongly influenced by
the degree of left ventricular dysfunction. In group 1 patients, surgical
mortality, sudden death, and total cardiac death are rare. In group 2,
sudden death rate may not be markedly different from that of group 1
patients. However, the risk of therapy (surgical mortality) is high. Many
nonsudden cardiac deaths are causally related to arrhythmia (surgical
mortality or nonsudden arrhythmia-related death). Therefore, the survival
rate free of total arrhythmia-related death is significantly lower in group
2 (70% versus 97% in group 1 at 3 years). Further studies are needed to
determine the roles of defibrillator therapy and other therapies in various
clinical settings.
ARTICLES
Influence of left ventricular function on outcome of patients treated with implantable defibrillators
Department of Medicine, Montefiore Medical Center/Moses Division, Bronx, NY 10467.
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