Usefulness of the automatic implantable cardioverter defibrillator in improving survival of patients with severely depressed left ventricular function associated with coronary artery disease.
Clinical outcome was analyzed among a group of 39 consecutive patients with coronary artery disease, left ventricular (LV) ejection fractions less than 30% and arrhythmias that required an automatic implantable cardioverter defibrillator (AICD) in an attempt to better define the role of the device in patients with severely depressed LV function. Twenty-nine (74%) were survivors of out-of-hospital cardiac arrest and 10 (26%) had ventricular tachycardia that was refractory to electrophysiologically guided antiarrhythmic therapy. The study group had the following demographic characteristics: 90% were men, mean age was 64 years (range 41 to 79) and mean LV ejection fraction was 21 +/- 4%. Concomitant pharmacotherapy included antiarrhythmic drugs 31 (79%), vasodilators in 22 (56%) and digoxin in 20 (51%). There was no statistical difference in baseline characteristics between survivors and nonsurvivors. Patients were followed for a mean of 24 months (range 2 to 72) from implantation. The difference between actuarial survival--77% at 1 year and 72% at 2 years--and projected survival without the AICD (patients who survive without appropriate device discharge)--30% at 1 year and 21% at 2 years--was significant (p less than 0.01 and less than 0.05 at 1 and 2 years, respectively). This study suggests that the AICD improves survival in patients with coronary artery disease despite severely depressed LV function.
de Marchena
E
E
Division of Cardiology, University of Miami, Florida.
Chakko
S
S
Fernandez
P
P
Villa
A
A
Cooper
D
D
Wozniak
P
P
Cruz
J
J
Thurer
R J
RJ
Kessler
K M
KM
Myerburg
R J
RJ
D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002302:Cardiac Output / Q000502:physiology; D003327:Coronary Disease / Q000503:physiopathology*; D004554:Electric Countershock / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D019736:Prostheses and Implants; D012008:Recurrence; D015996:Survival Rate; D013610:Tachycardia / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D016277:Ventricular Function, Left / Q000502:physiology*
D000889:Anti-Arrhythmia Agents