Incidence and clinical significance of multiple consecutive, appropriate, high-energy discharges in patients with implanted cardioverter-defibrillators

被引:117
作者
Villacastin, J [1 ]
Almendral, J [1 ]
Arenal, A [1 ]
Albertos, J [1 ]
Ormaetxe, J [1 ]
Peinado, R [1 ]
Bueno, H [1 ]
Merino, JL [1 ]
Pastor, A [1 ]
Medina, O [1 ]
Tercedor, L [1 ]
Jimenez, F [1 ]
Delcan, JL [1 ]
机构
[1] UNIV COMPLUTENSE MADRID,HOSP GEN GREGORIO MARANON,DEPT CARDIOL,FAC MED,LAB ELECTROFISIOL,E-28007 MADRID,SPAIN
关键词
defibrillation; survival; prognosis; tachyarrhythmias;
D O I
10.1161/01.CIR.93.4.753
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Some patients with an automatic implantable cardioverter-defibrillator (ICD) suffer multiple appropriate, consecutive, high-energy discharges (MCDs) during follow-up. Such events might represent resistant ventricular arrhythmias and might have prognostic significance. Methods and Results Eighty consecutive patients with an ICD were followed up for up to 82 months (mean, 21 +/- 19 months). Thirty-eight patients had survived an out-of-hospital cardiac arrest and 42 had recurrent ventricular tachycardia. During follow-up, 16 patients had MCD (group A), 26 patients had episodes of single appropriate discharges (group B), and 38 patients had no appropriate discharges (group C). Group A patients had worse functional status (P=.001), lower left ventricular ejection fractions (LVEFs) (P=.001), and lower survival rates (log rank, P=.003) than the remaining two groups of patients. Cox analysis showed LVEF (P=.001) to be an independent predictor of MCD. Independent predictors of death or heart transplant were MCD (P=.001), female sex (P=.001), age(P=.001), history of cardiac arrest (P=.003), and functional status (P=.003). The only independent predictor of total mortality was female sex (P=.002). Independent predictors of cardiac death were MCD (P=.007) and female sex (P=.018). Independent predictors of arrhythmic death were age (P=.001), female sex (P=.02), and MCD (P=.023). Conclusions In patients with an ICD, the development of MCD is an independent predictor of cardiac and arrhythmic mortality. If this finding is confirmed in larger studies, it may help to identify patients in whom other therapeutic alternatives, ie, heart transplantation, should be considered during follow-up after ICD implantation.
引用
收藏
页码:753 / 762
页数:10
相关论文
共 59 条
[1]   DIFFERENCES IN THE USE OF PROCEDURES BETWEEN WOMEN AND MEN HOSPITALIZED FOR CORONARY HEART-DISEASE [J].
AYANIAN, JZ ;
EPSTEIN, AM .
NEW ENGLAND JOURNAL OF MEDICINE, 1991, 325 (04) :221-225
[2]   ROLE OF TRIPLE EXTRASTIMULI DURING ELECTROPHYSIOLOGIC STUDY OF PATIENTS WITH DOCUMENTED SUSTAINED VENTRICULAR TACHYARRHYTHMIAS [J].
BUXTON, AE ;
WAXMAN, HL ;
MARCHLINSKI, FE ;
UNTEREKER, WJ ;
WASPE, LE ;
JOSEPHSON, ME .
CIRCULATION, 1984, 69 (03) :532-540
[3]   EVALUATION OF THE IMPLANTABLE CARDIOVERTER DEFIBRILLATOR IN SURVIVORS OF CARDIAC-ARREST - THE NEED FOR RANDOMIZED TRIALS [J].
CONNOLLY, SJ ;
YUSUF, S .
AMERICAN JOURNAL OF CARDIOLOGY, 1992, 69 (09) :959-962
[4]   THE RELATIONSHIP BETWEEN SUCCESSFUL DEFIBRILLATION AND DELIVERED ENERGY IN OPEN-CHEST DOGS - REAPPRAISAL OF THE DEFIBRILLATION THRESHOLD CONCEPT [J].
DAVY, JM ;
FAIN, ES ;
DORIAN, P ;
WINKLE, RA .
AMERICAN HEART JOURNAL, 1987, 113 (01) :77-84
[5]   CLINICAL PREDICTORS OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR SHOCKS (RESULTS OF THE CASCADE TRIAL) [J].
DOLACK, GL ;
GREENE, HL ;
POOLE, JE ;
KUDENCHUK, PJ ;
BARDY, GH ;
COBB, LA ;
GRAHAMRENFROE, EL ;
POWELL, JL ;
GALLOWAY, AC ;
KELLIE, J ;
FELLOWS, CL ;
MAIN, CL ;
MCMAHONBUSCH, M ;
BROUDY, DR ;
SANDERS, J ;
GARNI, JE ;
GERITY, D ;
MAYNARD, C ;
HALLSTROM, AP ;
MCBRIDE, R .
AMERICAN JOURNAL OF CARDIOLOGY, 1994, 73 (04) :237-241
[6]   CLINICAL-EXPERIENCE, COMPLICATIONS, AND SURVIVAL IN 70 PATIENTS WITH THE AUTOMATIC IMPLANTABLE CARDIOVERTER DEFIBRILLATOR [J].
ECHT, DS ;
ARMSTRONG, K ;
SCHMIDT, P ;
OYER, PE ;
STINSON, EB ;
WINKLE, RA .
CIRCULATION, 1985, 71 (02) :289-296
[7]  
ECHT DS, 1990, ELECTRICAL THERAPY C, P489
[8]   DIFFERENCES BETWEEN WOMEN AND MEN IN SURVIVAL AFTER MYOCARDIAL-INFARCTION - BIOLOGY OR METHODOLOGY [J].
FIEBACH, NH ;
VISCOLI, CM ;
HORWITZ, RI .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1990, 263 (08) :1092-1096
[9]   EFFICACY OF THE AUTOMATIC IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR IN PROLONGING SURVIVAL IN PATIENTS WITH SEVERE UNDERLYING CARDIAC DISEASE [J].
FOGOROS, RN ;
ELSON, JJ ;
BONNET, CA ;
FIEDLER, SB ;
BURKHOLDER, JA .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1990, 16 (02) :381-386
[10]   ACTUARIAL INCIDENCE AND PATTERN OF OCCURRENCE OF SHOCKS FOLLOWING IMPLANTATION OF THE AUTOMATIC IMPLANTABLE CARDIOVERTER DEFIBRILLATOR [J].
FOGOROS, RN ;
ELSON, JJ ;
BONNET, CA .
PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY, 1989, 12 (09) :1465-1473