Impact of viability, ischemia, scar tissue, and revascularization on outcome after aborted sudden death.
BACKGROUND
Survivors of aborted sudden death attributable to ventricular arrhythmias in the presence of coronary artery disease are at risk for recurrences. The substrate underlying these arrhythmias is not clear, and therefore the relation between ischemia, viability, scar tissue (and revascularization), and the incidence of ventricular arrhythmias (and survival) was studied over up to 3 years.


RESULTS
One hundred fifty-three survivors of sudden death underwent stress-rest perfusion imaging. Patients with ischemic/viable myocardium (n=73) were revascularized if possible. Final antiarrhythmic therapy was based on the outcome of electrophysiological testing or left ventricular ejection fraction (LVEF). Implantation of a defibrillator was performed in 112 (72%) patients. During 3-year follow-up, 15 cardiac deaths occurred and 42 (29%) patients had recurrent ventricular arrhythmias. Patients with events (death or recurrence) exhibited more often a severely depressed LVEF (< or =30%), more extensive scar tissue, and less ischemic/viable myocardium on perfusion imaging and less frequently underwent revascularization. Multivariate analysis identified extensive scar tissue and LVEF < or =30% as the only predictors of death/recurrent ventricular arrhythmias.


CONCLUSIONS
In patients with aborted sudden death, extensive scar tissue and severely depressed LVEF are the only predictors of death or recurrent ventricular arrhythmias. These patients should be considered for implantation of a defibrillator.
van der Burg
Alida E Borger
AE
Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.
Bax
Jeroen J
JJ
Boersma
Eric
E
Pauwels
Ernest K J
EK
van der Wall
Ernst E
EE
Schalij
Martin J
MJ
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation; D002921:Cicatrix / Q000000981:diagnostic imaging*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D013318:Stroke Volume; D016019:Survival Analysis; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data; D013667:Technetium; D015899:Tomography, Emission-Computed, Single-Photon; D016277:Ventricular Function, Left
D013667:Technetium