title: Comparison of outcome of implantable cardioverter defibrillator implantation in patients with severe versus moderately severe left ventricular dysfunction secondary to atherosclerotic coronary artery disease.
abstract: This study was undertaken to assess the feasibility and clinical outcome of implantable cardioverter-defibrillators (ICDs) among patients with coronary artery disease and left ventricular ejection fraction (LVEF) of <20%. The morbidity, mortality, and the long-term survival of 117 patients with LVEF of <20% (group 1) were compared with 321 patients with LVEF of 20% to 40% (group 2). Mortality in the first 30 days after ICD implantation was 0% for group 1 and 0.6% in group 2. Actuarial survival (all cause) at the end of 2, 4, and 5 years were 83%, 70%, and 62%, respectively, in group 1 and 90%, 80%, and 71% in group 2 (p = 0.05). Fifty-five patients (47%) in group 1 and 126 patients (39%) in group 2 received appropriate shocks during follow up. Among the patients in group 1, the overall survival at 2 years after an appropriate shock from an ICD was 92% for patients <60 years of age, 77% for patients ages 60 to 69, and 53% for patients >70 years old. Although the overall survival of patients in group 1 was slightly lower compared with those in group 2, in a multivariate analysis, the EF was not an independent predictor of poor survival. The ICD can be implanted with acceptable operative morbidity and mortality in selected patients with LVEF of <20%.
authors.affiliation: Electrophysiology Laboratory of Sinai Samaritan Medical Center, University of Wisconsin Medical School, Milwaukee Clinical Campus, USA.
authors.forename: C
authors.initials: C
authors.lastname: Narasimhan
authors.forename: A
authors.initials: A
authors.lastname: Dhala
authors.forename: K
authors.initials: K
authors.lastname: Axtell
authors.forename: A J
authors.initials: AJ
authors.lastname: Anderson
authors.forename: J
authors.initials: J
authors.lastname: Sra
authors.forename: S
authors.initials: S
authors.lastname: Deshpande
authors.forename: M R
authors.initials: MR
authors.lastname: Jazayeri
authors.forename: Z
authors.initials: Z
authors.lastname: Blanck
authors.forename: M
authors.initials: M
authors.lastname: Akhtar
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications*; D017147:Defibrillators, Implantable; D005240:Feasibility Studies; D005260:Female; D006331:Heart Diseases / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000145:classification / Q000209:etiology / Q000401:mortality / Q000628:therapy*