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Sudden death mortality in implantable cardioverter defibrillator patients
1Department of Cardiothoracic Surgery, Montefiore Medical Center, Bronx, New York 10467.
Insights
Implantable cardioverter defibrillators (ICDs) reduce but do not eliminate sudden cardiac death (SCD). Arrhythmic death remains the most common cause, especially in high-risk patients receiving ICDs.
Area of Science:
- Cardiology
- Medical Devices
Background:
- Sudden cardiac death (SCD) remains a significant concern.
- Implantable cardioverter defibrillators (ICDs) are used to prevent SCD.
- The absolute efficacy of ICDs in preventing SCD requires further investigation.
Purpose of the Study:
- To determine the frequency and nature of SCD in patients with ICDs.
- To analyze mortality causes in a cohort of ICD recipients.
Main Methods:
- Retrospective review of 56 consecutive patients who underwent ICD implantation.
- Follow-up data collected from May 1982 to May 1990.
- Analysis of mortality incidence and causes, including SCD and arrhythmic deaths.
Main Results:
- Twenty-one out of 56 patients died during the follow-up period.
- Sudden cardiac death (SCD) accounted for 33% of all mortality.
- Arrhythmic deaths represented 52% of total deaths, remaining the most common cause.
- Cumulative SCD survival rates at 1, 3, and 5 years were 93%, 89%, and 75%, respectively.
- All seven patients who died of SCD had experienced prior SCD events and received shocks.
- Two of these patients had devices that were likely inactive at the time of death.
Conclusions:
- ICDs significantly reduce but do not completely eliminate the risk of arrhythmic death.
- Patients at the highest risk for SCD remain susceptible to arrhythmic death despite ICD implantation.
- Device inactivity may contribute to treatment failure in some cases.
Abstract:
Implantable cardioverter defibrillator (ICD) prevention of sudden cardiac death (SCD) is not absolute and our experience was reviewed to determine the frequency and nature of SCD in this population. The incidence and cause of mortality in 56 consecutive patients, who underwent ICD implantation beginning May 1982 with follow-up through May 19, 1990 were analyzed. Twenty-one patients died, 33% of the mortality was due to SCD, and 52% of deaths may be considered arrhythmic. The cumulative 1, 3, and 5 year SCD survivals were 93%, 89%, and 75%. All seven patients dying of SCD presented initially with SCD, all received previous shocks prior to SCD, and two of the seven patients had devices that were probably inactive at the time of death. We conclude that ICDs reduce but by no means eliminate arrhythmic death, particularly in those at highest risk for SCD. Arrhythmic death remained the most common cause of death in this population.