title: Implantable defibrillator event rates in patients with idiopathic dilated cardiomyopathy, nonsustained ventricular tachycardia on Holter and a left ventricular ejection fraction below 30%.
abstract: OBJECTIVE
  This study investigated the incidence of appropriate implantable cardioverter defibrillator (ICD) interventions for ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients with idiopathic dilated cardiomyopathy (IDC) and nonsustained VT in the presence of a left ventricular ejection fraction below 30%, versus in patients with syncope and patients with a history of VT or VF.
  
  
  BACKGROUND
  To date, only limited information is available about the prophylactic use of ICDs in patients with IDC.
  
  
  METHODS
  From January 1993 to July 2000, 101 patients with IDC underwent implantation of ICDs with electrogram storage capability at our institution. Patients were placed into one of three groups according to their clinical presentation: asymptomatic or mildly symptomatic nonsustained VT in the presence of a left ventricular ejection fraction < or = 30% (49 patients, prophylactic group), unexplained syncope or near syncope (26 patients, syncope group) and a history of sustained VT or VF (26 patients, VT/VF group).
  
  
  RESULTS
  During 36 +/- 22 months follow-up, 18 of 49 patients (37%) in the prophylactic group received appropriate shocks for VT or VF, compared with 8 of 26 patients (31%) in the syncope group and with 9 of 26 patients (35%) of the VT/VF group. Multivariate Cox analysis of baseline clinical variables identified left ventricular ejection fraction, atrial fibrillation and a history of sustained VT or VF as predictors for appropriate ICD interventions during follow-up.
  
  
  CONCLUSIONS
  Patients with IDC and prophylactic ICD implantation for nonsustained VT in the presence of a left ventricular ejection fraction < or = 30% had an incidence of appropriate ICD interventions similar to that of patients with a history of syncope or sustained VT or VF. These findings indicate that ICDs may have a role in not only secondary but also primary prevention of sudden death in IDC.
authors.affiliation: Department of Cardiology, Hospital of the Philipps-University of Marburg, Marburg, Germany. wolfram.grimm@med.uni-marburg.de
authors.forename: Wolfram
authors.initials: W
authors.lastname: Grimm
authors.forename: J ürgen
authors.initials: Jü
authors.lastname: Hoffmann J
authors.forename: Hans Helge
authors.initials: HH
authors.lastname: Müller
authors.forename: Bernhard
authors.initials: B
authors.lastname: Maisch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000150:complications* / Q000503:physiopathology; D002311:Cardiomyopathy, Dilated / Q000150:complications* / Q000503:physiopathology; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology*; D013575:Syncope / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D017180:Tachycardia, Ventricular / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*