[Analysis of the cause of death of ICD patients during long-term follow-up].
BACKGROUND
Implantable cardioverter defibrillators represent an effective therapy to prevent sudden cardiac death in patients with ventricular arrhythmias. This implies a change in the spectrum of causes of death. There exist no large studies providing an exact differentiation of these causes of death.


METHODS
During a mean observation period of 41+/-29 months (3 d-12 yrs), we analyzed the outcome of 429 ICD patients (CAD n=274, dilative CMP n=97, others n=23, no structural heart disease n=35), mean age 62+/-12 years (23-87 yrs).


RESULTS
The overall survival rate was 79.7% whereby 3.5% of these patients underwent successful heart transplantation and 2.1% died suddenly. 60.9% of all deaths showed a non-sudden cardiac cause (heart failure 56.3%, myocardial infarction 4.6%). In 28.7% a non-cardiac fatal event was present (cancer 11.5%, septicemia 6.9%, stroke 4.6%). The deceased showed significantly more often structural heart disease (100 vs 92%, p<0.02) and a lower left ventricular ejection fraction (37+/-14 vs 44+/-18%, p<0.02). Significant higher survival rates were associated with medication with beta blockers (88 vs 75%, p<0.02) and the class III antiarrhythmic agents sotalol und amiodarone (85 vs 77%, p<0.03).


CONCLUSIONS
Mortality due to sudden death was reduced to 2.1% in ICD patients associated with a shift of causes of death towards severe heart failure. Therefore, special attention should be paid to the signs of heart failure in these patients to enable early initiation of appropriate therapeutic strategies.
Medizinische Klinik I, Klinikum der Ludwig-Maximilians-Universität München-Grosshadern, Marchioninistr. 15, 81377 München, Germany. Michael.Fiek@med.uni-muenchen.de
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Fiek
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Zieg
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Matis
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Hahnefeld
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Reithmann
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Steinbeck
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015897:Comorbidity; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome