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Ventricular fibrillation in patients without significant structural heart disease: a multicenter experience with
M D Meissner1, M H Lehmann, R T Steinman
1Wayne State University/Harper Hospital, Detroit, Michigan.
Insights
Survivors of ventricular fibrillation with minimal heart disease have excellent survival rates after receiving an implantable cardioverter-defibrillator. This therapy can prevent fatal outcomes from recurrent cardiac arrest in this patient group.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Prognosis for ventricular fibrillation survivors with minimal structural heart disease is unclear.
- Implantable cardioverter-defibrillators (ICDs) are increasingly used in these patients.
- Understanding ICD outcomes is crucial for managing this population.
Purpose of the Study:
- To characterize the outcomes of ventricular fibrillation survivors treated with an implantable cardioverter-defibrillator.
- To assess the long-term prognosis in patients with no or minimal structural heart disease.
- To evaluate the efficacy of ICD therapy in preventing adverse events.
Main Methods:
- Retrospective analysis of 28 patients with ventricular fibrillation and minimal/no structural heart disease.
- Patients received an implantable cardioverter-defibrillator.
- Follow-up included programmed electrical stimulation and monitoring of ICD events.
Main Results:
- 39% of patients had inducible ventricular tachyarrhythmias at baseline.
- No cardiac deaths occurred during a median 30.6-month follow-up.
- 16 patients received 88 shocks; only four received appropriate shocks for ventricular arrhythmias.
Conclusions:
- Implantable cardioverter-defibrillator recipients with minimal structural heart disease show excellent 3-year survival.
- Appropriate ICD shocks indicate a persistent risk of cardiac arrest.
- ICD therapy is effective in avoiding fatal outcomes in this patient group.
Objectives:
This study was undertaken to characterize the outcome of survivors of ventricular fibrillation with no or minimal structural heart disease who received an implantable cardioverter-defibrillator.
Background:
The prognosis among survivors of ventricular fibrillation with minimal or no structural cardiac abnormalities remains unclear. Since the advent of implantable cardioverter-defibrillators, this question takes on added importance.
Methods:
This 10-center retrospective study provided information on 28 survivors of ventricular fibrillation (mean age 42 years) with minimal or no structural abnormalities who were treated with an implantable cardioverter-defibrillator.
Results:
Ventricular tachyarrhythmias (polymorphic in all but one patient) were induced during baseline programmed stimulation in 39% of patients. During a median 30.6-month follow-up period after implantable cardioverter-defibrillator implantation, there were no cardiac deaths and two noncardiac deaths. Sixteen patients experienced 36 shock episodes (total 88 shocks). The majority of shocks were classified as "indeterminate"; one patient received 47 "spurious" shocks during one shock episode and each of four patients received one "appropriate" shock. Ventricular arrhythmias were not inducible in any of these latter four patients.
Conclusions:
Survivors of ventricular fibrillation with minimal or no structural cardiac abnormalities receiving an implantable cardioverter-defibrillator have an excellent 3-year survival rate. The occurrence, albeit infrequent, of appropriate implantable cardioverter-defibrillator shocks in this group suggests that these patients have a potential risk of recurrent cardiac arrest whose fatal outcome may be avoided by implantable cardioverter-defibrillator therapy.