Implantable cardioverter-defibrillator therapy in survivors of out-of-hospital sudden cardiac death without inducible arrhythmias

Brian G. Crandall, Cynthia D. Morris, Joel E. Cutler, Peter J. Kudenchuk, Jan L. Peterson, L. Bing Liem, David R. Broudy, H. Leon Greene, Blair D. Halperin, John H. McAnulty, Jack Kron

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41 Scopus citations

Abstract

Objectives. The aim of this study was to determine the efficacy of implantable cardioverter-defibrillator (ICD) therapy in survivors of sudden cardiac death in whom no ventricular arrhythmias can be induced with programmed electrical stimulation. Background. Survivors of sudden cardiac death in whom ventricular arrhythmias cannot be induced with programmed electrical stimulation remain at risk for recurrence of serious arrhythmias. Optimal protection to prevent sudden death in these patients is uncertain. This study compares survival in the subset of survivors of sudden cardiac death with that of patients treated with or without an ICD. Methods. A retrospective study was performed on 194 consecutive survivors of primary sudden death who had <-6 beats of ventricular tachycardia induced with programmed electrical stimulation with at least three extrastimuli. Ninety-nine patients received an ICD and 95 did not. Results. There were no significant differences between the two groups in presenting rhythm, number of prior myocardial infarctions or use of antiarrhythmic agents. Patients treated with an ICD were younger (55 ± 16 vs. 59 ± 11 years, p = 0.03) and had a lesser incidence of coronary artery disease (48% vs. 63%. p = 0.04) and a lower ejection fraction (0.43 ± 0.16 vs. 0.48 ± 0.18, p = 0.04). There were no significant differences between the groups in the use of revascularization procedures or antiarrhythmic agents after the sudden cardiac death. Patients treated with an ICD had an improvement in sudden cardiac death-free survival (p = 0.04) but the overall survival rate did not differ from that of the patients not so treated (p = 0.91). A mullivariate regression analysis that adjusted for the observed differences between the groups did not alter these results. Conclusions. Survivors of sudden cardiac death in whom no arrhythmias could be induced with programmed electrical stimlulation remained at risk for arrhythmia recurrence. Although the proportion of deaths attributed to arrhythmias was lower in the patients treated with an ICD, this therapy did not significantly improve overall survival.

Original languageEnglish (US)
Pages (from-to)1186-1192
Number of pages7
JournalJournal of the American College of Cardiology
Volume21
Issue number5
DOIs
StatePublished - Apr 1993

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Crandall, B. G., Morris, C. D., Cutler, J. E., Kudenchuk, P. J., Peterson, J. L., Liem, L. B., Broudy, D. R., Greene, H. L., Halperin, B. D., McAnulty, J. H., & Kron, J. (1993). Implantable cardioverter-defibrillator therapy in survivors of out-of-hospital sudden cardiac death without inducible arrhythmias. Journal of the American College of Cardiology, 21(5), 1186-1192. https://doi.org/10.1016/0735-1097(93)90244-U