Do patients with an implantable defibrillator live longer?
OBJECTIVE
This study was done to provide information on the potential benefit of implantable cardioverter-defibrillator therapy regarding sudden and arrhythmia-related deaths and to examine whether such therapy improves survival.


BACKGROUND
Implantation of automatic cardioverter-defibrillators is reported to abort sudden cardiac death due to malignant tachyarrhythmias.


METHODS
Between 1989 and 1992, 107 patients were screened for implantation of a third-generation implantable cardioverter-defibrillator combined with endocardial leads. Mean age was 57 +/- 13 years and mean ejection fraction was 40 +/- 15%. Sudden death, total arrhythmia-related death and total cardiac death were compared with the occurrence of fast ventricular tachyarrhythmias (> 240 beats/min), assuming that most of these arrhythmias would have been fatal without treatment by the implantable cardioverter-defibrillator.


RESULTS
The surgical mortality rate was 2.7% in all 107 patients and 1% in the 99 patients who qualified for endocardial leads. During a follow-up period of 12 +/- 8 months, actuarial survival rate free of events at 6 months as well as at 12 and 18 months was 100% for sudden death, 97% for total arrhythmia-related death and 95% for total cardiac death. In contrast, after 6, 12 and 18 months, the rate of survival free of fast ventricular tachycardia was only 83%, 74% and 69%, respectively, and the rate of survival free of any ventricular tachyarrhythmia was only 59%, 49% and 40%, respectively.


CONCLUSIONS
The outcome of patients treated with an implantable cardioverter-defibrillator and endocardial defibrillation leads is excellent. For many patients, this treatment is probably lifesaving.
Böcker
D
D
Department of Cardiology and Angiology, Westfälische-Wilhelms-Universität, Münster, Germany.
Block
M
M
Isbruch
F
F
Wietholt
D
D
Hammel
D
D
Borggrefe
M
M
Breithardt
G
G
D000328:Adult; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000517:prevention & control / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy*
D000889:Anti-Arrhythmia Agents