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Occurrence of ICD shocks and patient survival
1Department of Cardiothoracic Surgery, Montefiore Medical Center, Bronx, New York 10467.
Insights
Patients receiving implantable cardioverter defibrillators (ICDs) who experienced shocks had poorer survival rates. Device shocks indicate a negative prognosis, impacting overall patient outcomes.
Area of Science:
- Cardiology
- Medical Devices
Background:
- Implantable cardioverter defibrillators (ICDs) are crucial for managing life-threatening arrhythmias.
- Understanding factors influencing ICD patient outcomes is essential for clinical practice.
Purpose of the Study:
- To evaluate the prognostic significance of spontaneous shocks in patients with initial implantable cardioverter defibrillator (ICD) implantation.
- To compare clinical characteristics and survival rates between ICD patients who received shocks and those who did not.
Main Methods:
- Retrospective analysis of 56 consecutive patients who received an initial ICD implantation between May 1982 and January 1990.
- Comparison of clinical data and survival outcomes between patients experiencing spontaneous shocks (n=32) and those without shocks (n=21) over a mean follow-up of 31.5 months.
Main Results:
- No significant differences in baseline demographics or cardiac diagnoses were observed between the shock and no-shock groups.
- Patients experiencing shocks had a higher incidence of prior myocardial infarction (MI), lower ejection fraction, and had tried more medical regimens.
- 1-, 3-, and 5-year survival rates were significantly lower in the shock group (84%, 69%, 37%) compared to the no-shock group (93%, 93%, 93%).
Conclusions:
- Spontaneous ICD shocks are a negative prognostic indicator in patients with implantable cardioverter defibrillators.
- The absence of shocks is associated with an excellent prognosis, contributing significantly to the overall favorable outcomes observed in ICD patients.
Abstract:
Fifty-six consecutive patients who underwent initial implantation of an implantable cardioverter defibrillator (AICD) between May 1982 and January 1990 were analyzed. During a mean follow-up of 31.5 +/- 25 months, 32 (60%) patients experienced a spontaneous shock from their device. Their clinical characteristics and survival were compared to those of 21 patients without shocks. No statistically significant difference was found in the distribution between the two groups in age, sex, cardiac diagnosis, New York Heart Association Class, presenting arrhythmia, or mean follow-up (F/U). The group with shocks had a higher incidence of previous MI (P = 0.021) a lower mean ejection fraction (P = 0.023) and had been tried on a greater number of medical regimens (P = 0.003). The 1-, 3-, and 5-year cumulative survivals were 84%, 69%, and 37% in the group with shocks and 93%, 93%, and 93% for the group without shocks. Our data suggests that the occurrence of a shock is a negative prognostic indicator and that the excellent prognosis of patients without shocks contributes in large part to the favorable outcome of AICD patients.