Dlouhodobé přežívání pacientů s implantabilními kardiovertery – defibrilátory implantovanými ze sekundárně preventivních indikací

Long-lasting Survival of Patients with Implantable Cardioverter – Defibrillators Implanted from Secondary Preventive Reasons

Background.
The effectiveness of therapy with implantable cardioverter – defibrillators is usually evaluated according to the total mortality of ICD patients. The aim of this study is to analyse the total mortality of long-term followed ICD patients and to evaluate mortality according to the main diagnosis and analyse the influence of revascularization in patients with coronary artery disease. 

Methods and Results.
We have observed 138 consecutive patients in mean age of 62.0±12,2 year (108 M, 30 F) with mean LVEF 0.38±0,14, who had ICD implanted for malignant ventricular arrhythmias from X/95 to XII/02 from secondary preventive reasons. The mean follow-up was 47.35 months. 99 patients had coronary artery disease, 16 dilated cardiomyopathy, 5 right ventricle dysplazia, 4 LQT syndrome, 1 valvular disease and 13 pts were without structural heart disease. The total mortality of the group of patients was 22 % (31 patients). The terminal heart failure was the main cause of death in our pts – in 84 % of the cases. We had no sudden death in our group of pts. The highest mortality (27 %) was in pts with coronary artery disease, nobody died in the group of pts without structural heart disease. The higher mortality was in patients in pts where the revascularization was not possible before ICD implantation (38 % versus 20 %) One-year survival of the whole group of pts covered 90 % and two-year survival was 87 %. 

Conclusions.
The survival of ICD pts is shorter if coronary artery disease is present and there is no possibility to revascularize pts before ICD implantation. 

Key words:
ICD, total mortality, secondary prevention.