Predictors of automatic implantable cardioverter defibrillator discharge for life-threatening ventricular arrhythmias.
Data from 100 patients with life-threatening ventricular arrhythmias and automatic implantable cardioverter defibrillators (AICDs) were analyzed to determine if clinical, angiographic and electrophysiologic variables are predictive of AICD discharge. During a median follow-up period of 18 months, 45% of patients experienced greater than or equal to 1 device discharge during a documented ventricular arrhythmia or in association with presyncope or syncope ("appropriate" AICD discharge). Univariate predictors of appropriate AICD discharge included depressed left ventricular ejection fraction (p = 0.0007), inducible sustained ventricular arrhythmia at electrophysiologic study performed in the absence of antiarrhythmic drugs (p = 0.009), fewer number of extrastimuli required for induction at this study (p = 0.001), inducible sustained arrhythmia at electrophysiologic study performed on the discharge antiarrhythmic regimen (p = 0.0005) and fewer extrastimuli required for this induction (p less than 0.0001). Multivariate analysis identified the induction of a sustained ventricular arrhythmia by 1 or 2 extrastimuli during electrophysiologic study performed on the discharge regimen as the only independent predictor among the variables analyzed (p less than 0.0001). The probability of appropriate AICD discharge at 18 months was 86% for patients who had a sustained arrhythmia induced with 1 or 2 extrastimuli versus 15% for those requiring 3 extrastimuli for arrhythmia induction and 13% for patients without inducible sustained arrhythmias.
Kelly
P A
PA
Cardiac Unit, Massachusetts General Hospital, Boston, Massachusetts 02114.
Cannom
D S
DS
Garan
H
H
Finkelstein
D
D
McComb
J M
JM
Mirabal
G S
GS
Ilvento
J P
JP
Ruskin
J N
JN
D001145:Arrhythmias, Cardiac / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D004554:Electric Countershock / Q000295:instrumentation*; D005260:Female; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume