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Survival in patients with depressed left ventricular function treated by implantable cardioverter defibrillator
1Sinai Samaritan Medical Center, Mount Sinai Hospital, Milwaukee, Wisconsin 53233.
Insights
Implantable cardioverter defibrillators (ICDs) significantly improve survival in patients with poor left ventricular (LV) function. These devices prevent premature arrhythmic death, a major cause of mortality in this high-risk cardiovascular disease population.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Cardiovascular disease mortality often results from pump failure or lethal ventricular arrhythmias.
- Patients with ventricular tachycardia (VT), ventricular fibrillation (VF), and poor left ventricular (LV) function face particularly high mortality rates.
- The precise incidence of premature arrhythmic death in patients with impaired LV function remains unclear.
Purpose of the Study:
- To analyze mortality patterns in patients with poor LV function who received an implantable cardioverter defibrillator (ICD).
- To evaluate the impact of ICDs on survival in this specific patient cohort.
Main Methods:
- Retrospective analysis of 200 consecutive patients receiving ICDs.
- Identification of a subgroup (n=68) with LV ejection fraction (LVEF) < 30%.
- Assessment of appropriate ICD discharges and survival outcomes.
Main Results:
- 34% of patients had LVEF < 30%.
- 45% of this subgroup experienced appropriate ICD discharges, with 55% receiving multiple shocks.
- Projected 5-year survival was 11%, while actual survival reached 60% with ICD use.
- ICDs prolonged life even in patients who died from non-sudden causes.
Conclusions:
- ICDs have a substantial positive impact on survival for patients with poor LV function.
- Arrhythmia is a significant cause of premature mortality in this population.
- ICD implantation is a critical intervention for improving outcomes in patients with severely impaired LV function.
Abstract:
Mortality in patients with cardiovascular disease is generally due to pump failure or lethal ventricular arrhythmias. In patients with ventricular tachycardia (VT) or ventricular fibrillation (VF) and poor left ventricular (LV) function the death rate is particularly high. The overall incidence of premature arrhythmic death rate in patients with poor LV function is not totally clear. Since implantable cardioverter defibrillator (ICD) could prevent arrhythmic death in any population, we proceeded to analyze mortalities in patients with poor LV function who received ICD. Among a total of 200 consecutive patients receiving ICD at our institution, 68 (34%) had LV ejection fraction (LVEF) of less than 30%. Thirty-one of these (45%) experienced appropriate ICD discharges and 17/31 (55%) had multiple shocks. Survival curves in this population revealed a 5 year projected overall survival of 11% whereas an actual survival was 60%. Even those who ultimately died from nonsudden causes, life was prolonged by ICD in a significant number of cases. Based upon these findings it is concluded that ICD has a major impact on survival in patients with poor LV function suggesting that many of these patients die prematurely from arrhythmia causes.