#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Risk markers influencing mortality of patients with implantable cardioverter-defibrillators


Authors: M. Kozák;  L. Křivan;  M. Sepši;  J. Vlašínová
Authors‘ workplace: Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC
Published in: Vnitř Lék 2005; 51(11): 1266-1271
Category: Original Contributions

Overview

Objective:
The effectivity of ICD therapy 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 describe potential markers increasing mortality.

Patients and methods:
We have observed 138 consecutive patients in mean age of 62.0 ± 12.2 year (108 M, 30 F) with mean LV EF 0.38 ± 0.14, who had ICD implanted for malignant ventricular arrhythmias from X/95 to XII/02. The mean follow-up was 47.35 months. 99 patients had CAD (coronary artery disease), 16 CMP (dilated cardiomyopathy), 5 ARVC (right ventricle dysplazia) , 4 LQT syndrom, 1 valvular disease and 13 pts were without structural heart disease.

Results:
The total mortality of the group of patients was 22 % (31 patients). The terminal heart failure was the main cause of death in our patients - in 84 % of the cases. We had no sudden death in our group of patients. There were no statistically significant differences observed between males and females. The statistically significant higher mortality was in patients above 66 years old, with severe left ventricle dysfunction - LV EF < 0.35 (18 % versus 8 %), in patients where the revascularization was not possible before ICD implantation (38 % versus 20 %) and then in patients with an arrhythmic storm after ICD implantation (37 % versus 17 %). The highest mortality (27 %) was in patients with CAD, nobody died in the group of patients without structural heart disease. One-year survival of the whole group of pts covered 90 % and two-year survival was 87 %.

Conclusions:
The survival of ICD patients is limited minimaly due to four factors: prior ICD implantation there is impossibility to revascularize patients with CAD, low LV EF < 0.35, age above 66 years and after ICD implantation the highest mortality occured to patients with arrhythmic storm during follow-up.

Key words:
ICD survival - mortality - risk markers


Sources

1. Bigger JT, Fleiss JL, Kleiger R et al. The Multicenter Post Infarction Program: The relationship between ventricular arrhythmias, left ventricular dysfunction and mortality in the years after myocardial infarction. Circulation 1984; 69: 250–258.

2. Cobb LA, Weaver WD, Fahrenbruch CE et al. Community–based interventions for sudden cardiac death: Impact, limitations, and changes. Circulation 1992; 85: I–98–I–102.

3. Credner S, Klingenheben T, Mauss O et al. Electrical storm in patients with transvenous implantable cardioverter-defibrillators. JACC 1998; 32: 1909–1915.

4. Every N, Fahrenbruch C, Hallstrom A et al. Influence of coronary bypass surgery on subsequent outcome of patients resuscitated from out hospital cardiac arrest. J Am Coll Cardiol 1992; 19: 1435–1439.

5. Exner VD, Pinski SL, Wyse G et al. Electrical storm presages nonsudden death. The antiarrhythmics versus implantable defibrillators (AVID) trial. Circulation 2001; 24: 2066–2071.

6. Fogoros RN, Elson JJ, Bonnet CA et al. Efficacy of the automatic implantable cardioverter defibrillator in prolonging survival in patients with severe heart disease. J Am Cardiol 1990; 16; 381–386.

7. Gordon T, Kannel WB. Premature mortality from coronary heart disease. The Framingham study. JAMA 1971; 215: 1617–1625.

8. Greene M, Newman D, Geist M et al. Is electrical storm in ICD patients the sign of a dying heart? Europace 2000; 2: 263–269.

9. Christakis GT, Weisel RD, Fremes SE et al. Coronary artery by-pass grafting in patients with poor ventricular function. Cardiovascular surgeons of the University of Toronto. J Thorac Cardiovasc Surg 1992; 103: 1083–1091.

10. Kjekshus J Arrhythmias and mortality in congestive heart failure. Am J Cardiol 1990; 65: 42I–48I.

11. Kuck KH, Cappato R, Siebles J. ICD Therapy. Clinical approaches to tachyarrhythmias. Armonk, New York: Futura publishing Company, Inc. 1996; 5: 69.

12. Manolis A, Rastegar H, Estes M. Effects of coronary artery bypass grafting on ventricular arrhythmias: results with electrophysiologic testing and long-term follow-up. PACE 1993; 16: 984–991.

13. Myerburg RJ, Kessler KM, Estes D et al. Long-term survival after prehospital cardiac arrest: Analysis of outcome during an 8 year study. Circulation 1984; 70: 538–546.

14. Myerburg R, Castellanos A. Cardiac arrest and sudden cardiac death. In: Braunwald Textbook of Heart Disease, 6th edition , 2001.

15. Novák M, Kamarýt P, Dvořák I jr et al. ICD lead-related complications. Mid- -term follow-up of 172 patients with nonthoracotomy implantation. Cor Vasa 2004; 46: 311–318.

16. Pfeffer MA, Braunwald E, Moye LA et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. New Engl J Med 1992; 327: 669–677.

17. Pires L, Hull M, Nino Ch et al. Sudden death in recipients of transvenous implantable cardioverter defibrillator systems. J Cardiovasc Electrophysiol 1999; 10: 1049–1056.

18. Pisa Z Sudden death: a worldwide problem. In: Kulbertus H, Wellens HJJ (eds). Sudden Death. The Hague, The Netherlands: Martinus Nijhoff; 1980: 3–10.

19. Pitschner HF, Neuzner J, Himmrich E et al. Implantable cardioverter–difibrillator therapy: Influence of left ventricular function on long-term results. J Cardiovasc Electrophysiol 1999; 10: 1049–1056.

20. Stevenson WG, Stevenson LW, Middlekauf HR. Improving survival for patients with advanced heart failure a study of 737 consecutive patients. J Am Coll Cardiol 1995; 26: 1417–1423.

21. The CIBIS Investigators. A randomized trial of beta-blockade in heart failure: The Cardiac Insuficiency Bisoprolol Study (CIBIS). Circulation 1994; 90: 1765–1773.

22. The CONSENSUS Trial Study Group. Effects of enalapril on mortality in severe congestive heart failure. N Engl J Med 1987; 316: 1429–1435.

23. The SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. New Engl J Med 1991; 325: 303–310.

24. Tresh D, Wetherbee J, Siegel R et al. Long-term follow-up of survivors of prehospital sudden cardiac death treated with coronary bypass surgery. Am Heart J 1985; 110: 1139–1145.

25. Wiesfeld ACP, Crijns HJGM, Hillege HL et al. The clinical significance of coronary anatomy in post-infarct patients with late sustained ventricular tachycardia or ventricular fibrilation. Eur Heart J 1995; 16: 818–824.

Labels
Diabetology Endocrinology Internal medicine

Article was published in

Internal Medicine

Issue 11

2005 Issue 11

Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#