Influence of implantable cardioverter-defibrillators on the long-term prognosis of survivors of out-of-hospital cardiac arrest.

Abstract

BACKGROUND Survivors of out-of-hospital cardiac arrest not associated with acute myocardial infarction are at high risk for recurrent cardiac arrest and sudden cardiac death. The impact of the implantable cardioverter-defibrillator on long-term prognosis in these patients is uncertain. METHODS AND RESULTS Three hundred thirty-one survivors of out-of-hospital cardiac arrest (age, 56 +/- 13.7 years) underwent electrophysiologically guided therapy. Implantable defibrillators were placed in 150 patients (45.3%), and 181 patients (54.7%) received pharmacological and/or surgical therapy alone. Left ventricular ejection fraction was 35.2 +/- 16.6% in defibrillator recipients and 45.3 +/- 18.2% in nondefibrillator patients. Median patient follow-up was 24 months in the defibrillator group and 46 months in the nondefibrillator group. In a proportional hazards model, the independent predictors of total cardiac mortality were left ventricular ejection fraction of less than 0.40 (relative risk, 4.55; 95% confidence interval, 2.44 to 8.33; P = .0001), absence of an implantable defibrillator (relative risk, 2.70; confidence interval, 1.41 to 5.00; P = .017), and persistence of inducible sustained ventricular tachycardia (relative risk, 1.84; 95% confidence interval, 0.97 to 3.49; P = .045). The 1- and 5-year probabilities of survival free of cardiac mortality in patients with left ventricular ejection fraction of less than 0.40 were 94.3% and 69.6% with a defibrillator and 82.1% and 45.3% without a defibrillator, respectively. For patients with left ventricular ejection fraction of 0.40 or more, the 1- and 5-year probabilities of survival free of cardiac mortality were 97.7% and 94.6% with a defibrillator and 95.4% and 86.9% without a defibrillator, respectively. CONCLUSIONS In survivors of out-of-hospital cardiac arrest, the implantable defibrillator is associated with a reduction in cardiac mortality, particularly in patients with impaired left ventricular function.

Early Defibrillation and Circulatory Support Can Provide Better Long-Term Outcomes Through Favorable Neurological Recovery in Patients With Out-of-Hospital Cardiac Arrest of Cardiac Origin

“…16 However, there have been very few detailed reports on the incidences of the recurrence of lethal arrhythmias and the efficacy of use of an implantable cardioverter defibrillator for preventing sudden cardiac arrest in OHCA patients during a long-term follow-up. [18][19][20][21] Ruppel et al reported that among 40 patients who had survived an episode of ventricular fibrillation and subsequently received an implantable cardioverter defibrillator, 41 episodes of ventricular arrhythmias were documented in 13 patients (33%). 22 In the present study, we also found implantable cardioverter defibrillator discharge in 2 (22%) of the 9 survivors.…”

Survival Benefit of the Implantable Cardioverter-Defibrillator in Patients on the Waiting List for Cardiac Transplantation

“…[1][2][3] Patients with end-stage heart failure listed for cardiac transplantation are at high risk of sudden cardiac death while on the waiting list. [4][5][6] Of all deaths in patients on the waiting list, Յ70% occur suddenly.…”

Destructive Device Removal - Sparks and Deletion of Therapy History From an Implantable Cardioverter Defibrillator

“…However, several clinical studies [1][2][3] have demonstrated that the annual incidence of sudden death in patients with ICDs is presumed to be approximately 2%. Sudden death cannot be completely avoided even after ICD therapy.…”

“…Takashi Kurita, 1 MD, Shigeyuki Ueda, 2 MD, Hideo Okamura, 2 MD, Takashi Noda, 2 MD, Kazuhiro Satomi, 2 MD, Kazuhiro Suyama, 2 MD, Wataru Shimizu, 2 MD, Naohiko Aihara, 2 MD, Shunichi Miyazaki, 1 MD and Shiro Kamakura, 2 MD,…”