Implantable cardioverter-defibrillator therapy in survivors of out-of-hospital sudden cardiac death without inducible arrhythmias

Crandall, Brian G.; Morris, Cynthia D.; Cutler, Joel E.; Kudenchuk, Peter J.; Jc, Peterson; Liem, L. Bing; Broudy, David; Greene, H. Leon; Halperin, Blair D.; McAnulty, John H.; Kron, Jack

doi:10.1016/0735-1097(93)90244-u

Cited by 37 publications

(5 citation statements)

References 24 publications

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“…[64-68J However, the AICD has not been demonstrated to improve overall survival in some uncontrolled studies. [69,70] Prospective, randomised, controlled trials are currently in progress to determine the effect of the AICD on overall mortality (table IX). Propafenone was stopped in the Cardiac Arrest Study Hamburg because preliminary results showed a significantly higher total mortality and cardiac arrest recurrence in patients randomised to propafenone compared with those randomised to AICD therapyJ71 1 AICD therapy was also added to the protocol of the Cardiac Arrest in Seattle: Conventional Versus Amiodarone Drug Evaluation Study because a high percentage of patients developed ventricular fibrillation during follow-up.l46] Until the results of these clinical trials are available, I recommend using the AICD at the present time in elderly © Adis International Limited.…”

Section: Invasive Interventionmentioning

confidence: 99%

The Management of Ventricular Arrhythmias in Older Patients After CAST

Aronow

1995

Drugs & Aging

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Asymptomatic nonsustained ventricular tachycardia and complex ventricular arrhythmias in elderly persons without heart disease should not be treated with antiarrhythmic drugs. Nonsustained ventricular tachycardia and complex ventricular arrhythmias in elderly persons are associated with an increased incidence of coronary events, primary ventricular fibrillation and sudden cardiac death, especially if abnormal left ventricular ejection fraction, left ventricular hypertrophy or silent ischaemia are present. beta-Blockers should be used in the treatment of elderly patients with ventricular tachycardia or complex ventricular arrhythmias associated with ischaemic or nonischaemic heart disease if there are no contraindications to beta-blocker therapy. I would reserve the use of amiodarone in the treatment of ventricular tachycardia or complex ventricular arrhythmias to life-threatening ventricular tachyarrhythmias in elderly patients who cannot tolerate or who do not respond to beta-blockers. Angiotensin converting enzyme (ACE) inhibitors should be used in treating elderly patients with ventricular tachycardia or complex ventricular arrhythmias associated with congestive heart failure. In patients with ventricular tachycardia or complex ventricular arrhythmias associated with asymptomatic left ventricular systolic dysfunction, I would use beta-blockers plus ACE inhibitors. If elderly patients have life-threatening, recurrent ventricular tachycardia or ventricular fibrillation resistant to antiarrhythmic drugs, invasive intervention is indicated. Until the results of prospective, randomised, clinical trials evaluating the automatic implantable cardioverter-defibrillator are available, I recommend using the automatic implantable cardioverter-defibrillator in elderly patients who have medically refractory sustained ventricular tachycardia or ventricular fibrillation.

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Section: Invasive Interventionmentioning

confidence: 99%

The Management of Ventricular Arrhythmias in Older Patients After CAST

Aronow

1995

Drugs & Aging

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“…However, there was no change in overall mortality compared with those without an ICD. Patients with an ICD were younger and had significantly less coronary artery disease, which may have biased the results [ 51 ]. A prospective study of 204 patients post-cardiac arrest identified a significant reduction in mortality in patients (with inducible tachycardia) receiving ICD compared with those receiving antiarrhythmic agents.…”

Section: Interventionsmentioning

confidence: 99%

Clinical review: Beyond immediate survival from resuscitation – long-term outcome considerations after cardiac arrest

Arawwawala

Brett

2007

Critical Care

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A substantial body of literature concerning resuscitation from cardiac arrest now exists. However, not surprisingly, the greater part concerns the cardiac arrest event itself and optimising survival and outcome at relatively proximal time points. The aim of this review is to present the evidence base for interventions and therapeutic strategies that might be offered to patients surviving the immediate aftermath of a cardiac arrest, excluding components of resuscitation itself that may lead to benefits in long-term survival. In addition, this paper reviews the data on long-term impact, physical and neuropsychological, on patients and their families, revealing a burden that is often underestimated and underappreciated. As greater numbers of patients survive cardiac arrest, outcome measures more sophisticated than simple survival are required. IntroductionSurvival to a particular time after an 'index' cardiac arrest event, as recommended by the Utstein guidelines [1], is the most commonly reported outcome measure for resuscitation, with hospital discharge and 1-year survival often reported. Excessive mortality risk is greatest within the first year after arrest and, after 2 years, approaches that of an age-and gender-matched population [2]. A retrospective review of inhospital mortality identified neurological injury as the mode of early death in two thirds of out-of-hospital cardiac arrest (OOHCA) patients admitted to intensive care. Cardiovascular death and multi-organ failure death accounted for the remainder [3]. A number of studies have investigated survival rates at greater than 1 year and how survival following OOHCA has changed over time. Such studies suggest that longer-term survival figures are improving [4][5][6][7]. This may be due to changes in coronary artery disease patterns, resuscitation practice, and/or subsequent medical intervention.With greater numbers of patients now surviving for longer periods, survival alone may be an inadequate assessment of resuscitation and post-resuscitation care. A more suitable tool may be assessment of quality of life (QOL) after hospital discharge. This requires an understanding of the psychosocial impact of cardiac arrest and its sequelae on the survivor and associated family members.The aim of this review is to present the evidence base for interventions and therapeutic strategies that might be offered to patients surviving the immediate aftermath of an OOHCA (excluding components of resuscitation itself) which may lead to benefits in long-term survival. In addition, this paper reviews the data on long-term impact, both physical and neuropsychological, on patients and their families. MethodologySearch terms recommended by the American Heart Association [8] and International Liaison Committee on Resuscitation (ILCOR) were used. These were used by working parties evaluating evidence for the ILCOR 2005 Consensus statement [9].An electronic search of the literature by means of PubMed was conducted using MeSH (Medical Subject Heading) main search terms 'heart a...

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“…Uncontrolled clinical trials have demonstrated that the AICD is very effective in reducing sudden cardiac death and total cardiac death in patients with life‐threatening ventricular tachyarrhythmias 65–69 . However, the AICD has not been shown to improve overall survival in some uncontrolled studies 70,71 …”

Section: Medical Therapymentioning

confidence: 99%

Treatment of Ventricular Arrhythmias in Older Adults

Aronow

1995

J American Geriatrics Society

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VA in older persons without heart disease should not be treated with antiarrhythmic drugs. Class I antiarrhythmic drugs should not be used to treat VA in older persons with heart disease. Beta blockers should be used to treat complex VA in older persons with ischemic or nonischemic heart disease if there are no contraindications to beta blocker therapy. The use of amiodarone in treating complex VA should be reserved for life-threatening ventricular tachyarrhythmias in older persons who cannot tolerate or who do not respond to beta blockers. VA associated with congestive heart failure should be treated with angiotensin converting enzyme inhibitors. If older patients have life-threatening recurrent ventricular tachycardia or ventricular fibrillation resistant to antiarrhythmic drugs, invasive intervention should be performed. The automatic implantable cardioverter-defibrillator is recommended in older patients who have medically refractory sustained ventricular tachycardia or ventricular fibrillation.

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Implantable cardioverter-defibrillator therapy in survivors of out-of-hospital sudden cardiac death without inducible arrhythmias

Cited by 37 publications

References 24 publications

The Management of Ventricular Arrhythmias in Older Patients After CAST

The Management of Ventricular Arrhythmias in Older Patients After CAST

Clinical review: Beyond immediate survival from resuscitation – long-term outcome considerations after cardiac arrest

Treatment of Ventricular Arrhythmias in Older Adults

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