Automatic implantable cardioverter defibrillators and survival of patients with left ventricular dysfunction and malignant ventricular arrhythmias.
OBJECTIVE
To assess survival after insertion of automatic implantable cardioverter defibrillators in high-risk patients who have malignant ventricular arrhythmias and left ventricular dysfunction.


METHODS
Actual survival time compared with arrhythmia-free time in a single group of patients.


METHODS
Inpatient services of a tertiary referral center and outpatient follow-up.


METHODS
Seventy consecutive patients with clinical sustained ventricular tachycardia or fibrillation whose arrhythmia could not be controlled by medication as determined by programmed electrical stimulation, and who had an automatic cardioverter defibrillator implanted.


METHODS
All patients received an implantable defibrillator.


RESULTS
Two-year survival was 93.4% (95% CI, 87 to 99.8) and projected survival based on recurrence of malignant arrhythmias was 60.3% (CI, 47.3 to 73.3; P less than 0.001). In the 25 patients with left ventricular ejection fraction less than 30%, actual survival was 86.7% (CI, 72.3 to 91.1) and projected survival was 56.9% (CI, 35.9 to 77.9; P = 0.025). Projected survival percentages are similar to survival figures reported in the literature for such high-risk patients. There was only one sudden death; the remaining deaths were not arrhythmic in nature. Of the 65 patients who were alive at the end of follow-up, 13 were in New York Heart Association Class I; 44, Class II; 5, Class III; and 3, Class IV.


CONCLUSIONS
The automatic implantable cardioverter defibrillator is probably highly effective in preventing arrhythmic mortality even in high-risk patients. Such treatment does not appear to significantly impair a patient's functional status.
Tchou
P J
PJ
Sinai Samaritan Medical Center, Milwaukee, Wisconsin.
Kadri
N
N
Anderson
J
J
Caceres
J A
JA
Jazayeri
M
M
Akhtar
M
M
D000206:Actuarial Analysis; D000368:Aged; D001026:Coronary Artery Bypass; D003645:Death, Sudden / Q000517:prevention & control; D004554:Electric Countershock / Q000295:instrumentation*; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D019736:Prostheses and Implants; D012008:Recurrence; D013318:Stroke Volume; D013610:Tachycardia / Q000401:mortality / Q000628:therapy*; D014693:Ventricular Fibrillation / Q000401:mortality / Q000628:therapy*