Long-term follow up of patients with implantable cardioverter-defibrillators and mild, moderate, or severe impairment of left ventricular function.

H. J. Trappe, P. Wenzlaff, P. Pfitzner, H. G. Fieguth

Department of Cardiology and Angiology, University Hospital Herne, Ruhr University Bochum, Germany.

OBJECTIVE: To determine whether patients with life threatening ventricular tachyarrhythmias, impaired left ventricular function, and severe heart failure will benefit from implantable cardioverter-defibrillator (ICD) treatment. DESIGN: 410 patients were followed up after ICD implant. Left ventricular function was assessed by the New York Heart Association (NYHA) functional class of heart failure: 50 patients (12%) were in NYHA I-II, 151 (37%) in NYHA II, 117 (29%) in NYHA II-III, and 92 (22%) in NYHA III. Epicardial ICD implantation was performed in 209 patients (51%) and 201 patients (49%) received non-thoracotomy ICDs. RESULTS: Perioperatively, 12 patients (3%) died, more often after epicardial ICD implant (11/209 patients, 5%) than after transvenous implant (1/201 patients, < 1%) (P < 0.05). During a mean (SD) follow up of 28 (24) months (range < 1 to 114 months), 90 patients (23%) died: nine (2%) died from sudden arrhythmia; five (1%) also died suddenly but probably not from arrhythmic causes; 55 (14%) died from cardiac causes (congestive heart failure, myocardial reinfarction); 21 (5%) died from non-cardiac causes. The three year, five year, and seven year survival was 92-96% for arrhythmic mortality in NYHA class I, II and III, compared to a three year survival of 94% and a five year and seven year survival of 84% for patients in NYHA class II-III. 338 patients (82%) received ICD shocks (21 (SD 43) shocks per patient); patients in NYHA class II (83%), class II-III (84%), and class III (90%) received ICD discharges more often than those in class I-II (64%) (P < 0.05). The mean (SD) time interval between ICD implant and the first ICD shock was shorter in NYHA class II (16 (17) months), class II-III (19 (27) months), and class III (16 (19) months) than in class 0-I (22 (24) months) (P < 0.05). CONCLUSIONS: Patients with mild, moderate, and severe left ventricular dysfunction benefit from ICD treatment and these patients survive for a considerable time after the first shock. Survival is influenced by the degree of left ventricular dysfunction; aggressive treatment of heart failure is necessary as well as ICD therapy.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Ypenburg, C., van Erven, L., Bleeker, G. B., Bax, J. J., Bootsma, M., Wijffels, M. C., van der Wall, E. E., Schalij, M. J. (2006). Benefit of Combined Resynchronization and Defibrillator Therapy in Heart Failure Patients With and Without Ventricular Arrhythmias. J Am Coll Cardiol 48: 464-470 [Abstract] [Full Text]  
• Lampert, R., McPherson, C. A., Clancy, J. F., Caulin-Glaser, T. L., Rosenfeld, L. E., Batsford, W. P. (2004). Gender differences in ventricular arrhythmia recurrence in patients with coronary artery disease and implantable cardioverter-defibrillators. J Am Coll Cardiol 43: 2293-2299 [Abstract] [Full Text]  
• Whang, W., Mittleman, M. A., Rich, D. Q., Wang, P. J., Ruskin, J. N., Tofler, G. H., Muller, J. E., Albert, C. M., for the TOVA Investigators, (2004). Heart Failure and the Risk of Shocks in Patients With Implantable Cardioverter Defibrillators: Results From the Triggers Of Ventricular Arrhythmias (TOVA) Study. Circulation 109: 1386-1391 [Abstract] [Full Text]  
• Higgins, S. L., Yong, P., Scheck, D., McDaniel, M., Bollinger, F., Vadecha, M., Desai, S., Meyer, D. B., for the Ventak CHF Investigators, (2000). Biventricular pacing diminishes the need for implantable cardioverter defibrillator therapy. J Am Coll Cardiol 36: 824-827 [Abstract] [Full Text]