Time to first shock and clinical outcome in patients receiving an automatic implantable cardioverter-defibrillator

Myerburg, Robert J.; Luceri, Richard M.; Thurer, Richard J.; Cooper, Deborah K.; Zaman, Liaqat; Interian, Alberto; Fernández, Pedro; Cox, Malcolm; Glicksman, Frances; Castellanos, Agustín

doi:10.1016/0735-1097(89)90209-x

Cited by 126 publications

(23 citation statements)

References 9 publications

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“…Electrocardiographic documentation at the time of ICD shock was not available for all patients. However, the criteria for appropriate shock used in our study are in accordance with criteria used by other investigators [3, 8, 9, 14]. The fact that our data regarding shock incidence are similar to the results of other investigators [15, 16], ranging from 62 to 69% in 5 years, make it unlikely that we overestimated the incidence of appropriate shocks.…”

Section: Discussionsupporting

confidence: 76%

“…In contrast to other reports [8, 17, 18, 19, 20, 21, 22]in our study left-ventricular ejection fraction was not independently associated with dependent variables, i.e. higher cardiac and total death.…”

Section: Discussioncontrasting

confidence: 56%

“…This difference may be due to differences in the patient population in these studies as well as the cutoff points for low ejection fraction which are defined arbitrarily. Of note, reviewing the literature [8, 18, 19, 20, 21, 22]there are at least three different cutoff points for low ejection fraction ranging between 25 and 45%, and the fact that this wide range of ejection fraction affected the mortality in different patient populations may also indicate that ejection fraction per se is not the strongest predictor for mortality. Therefore, we chose three categories of ejection fraction with cutoff points corresponding to preserved, moderately depressed and severely depressed ejection fraction covering this range and did not detect any significant difference in mortality among these three groups.…”

Section: Discussionmentioning

confidence: 99%

“…However, overall mortality in such patients remains high [1, 8]. It is therefore of interest to identify the impact of clinical characteristics on survival in patients treated with ICD.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Outcome in Patients with Implantable Cardioverter Defibrillators

Anvari

Gottsauner‐Wolf²,

Türel³

et al. 1998

Cardiology

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This study determined the impact of clinical characteristics on shock occurrence and survival in patients with implantable cardioverter-defibrillator (ICD). Methods and Results: During a follow-up of 27 ± 18 months, the actuarial incidence of appropriate shocks in 200 consecutive patients was 18, 36 and 72% at 1, 3, and 5 years, respectively. Coronary artery disease was the only significant predictor for shock occurrence (relative risk 1.32, p = 0.03). The actuarial incidence of total mortality was 10, 17 and 33% at 1, 3, and 5 years, respectively. The most powerful predictors for total mortality were: New York Heart Association functional class (NYHA) III (relative risk 4.8, p = 0.001) and a history of congestive cardiac failure (relative risk 3.6, p = 0.01). Conclusion: During long-term follow-up, the majority of patients receive appropriate shocks. No strong predictors for shock occurrence can be identified from the data analyzed. A history of congestive cardiac failure and the NYHA III are the most powerful predictors for total mortality. These clinical factors may provide valuable criteria to identify patients who will benefit from the implantation of ICD.

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Section: Discussionsupporting

confidence: 76%

Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

“…However, overall mortality in such patients remains high [1, 8]. It is therefore of interest to identify the impact of clinical characteristics on survival in patients treated with ICD.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Predictors of Outcome in Patients with Implantable Cardioverter Defibrillators

Anvari

Gottsauner‐Wolf²,

Türel³

et al. 1998

Cardiology

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“…52 However, underreporting is unlikely to be the cause for our finding that antiarrhythmic drug use, especially amiodarone, is associated with high defibrillation thresholds since the prevalence of antiarrhythmic drug use, including amiodarone, in our patients does exceed that in most other previously reported series. [53][54][55][56]58 Interestingly, in the one study in which amiodarone use was more frequent than in our study, patient entry was restricted to those with defibrillation thresholds .20 J,57 i.e., patients with high defibrillation thresholds were excluded.…”

Section: Study Limitationsmentioning

confidence: 99%

Clinical characteristics and outcome of patients with high defibrillation thresholds. A multicenter study.

et al. 1992

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BACKGROUND Successful defibrillation by an implantable cardioverter-defibrillator (ICD) depends on its ability to deliver shocks that exceed the defibrillation threshold. This study was designed to identify clinical characteristics that may predict the finding of an elevated defibrillation threshold and to describe the outcome of patients with high defibrillation thresholds. METHODS AND RESULTS The records of 1,946 patients from 12 centers were screened to identify 90 patients (4.6%) with a defibrillation threshold greater than or equal to 25 J. Excluding three patients who received ICDs that delivered greater than 30 J, there were 81 men and six women with a mean age of 59.5 +/- 10.1 years, a mean left ventricular ejection fraction of 0.32 +/- 0.14, and a 76% prevalence of coronary artery disease. Sixty-one patients (70%) were receiving antiarrhythmic drugs, and 45 (52%) were receiving amiodarone. Seventy-one patients (82%) received an ICD. Death occurred in 27 patients--19 of the 71 (27%) with an ICD (eight arrhythmic), and eight of the 16 (50%) without an ICD (four arrhythmic). Actuarial survival for all patients at 5 years was 67%. Actuarial survival rates at 2 years for patients with and without an ICD were 81% and 36%, respectively (p = 0.0024). Actuarial survival at 5 years for the ICD patients was 73%; no patient without an ICD has lived longer than 32 months. Actuarial survival free of arrhythmic death in the ICD patients at 5 years was 84%. Although the only variable to predict survival was ICD implantation (p = 0.003), it is entirely possible that in this retrospective analysis, clinical selection decisions to implant or to not implant an ICD differentiated patients destined to have better or worse outcomes, respectively. CONCLUSIONS Antiarrhythmic drug use may be causally related to the finding of an elevated defibrillation threshold. When patients with high defibrillation thresholds receive an ICD, arrhythmic death remains an important risk (42% of deaths in these patients were arrhythmia related, with 16% actuarial incidence at 5 years). Vigorous testing to optimize patch location can potentially benefit patients by enhancing the margin of safety for effective defibrillation.

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Pharmacological Effects of Antiarrhythmic Drugs

Kowey¹

1998

Arch Intern Med

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Most antiarrhythmic drugs are potent compounds with a relatively narrow therapeutic index. When prescribed judiciously, they can have a key role in enhancing or prolonging the lives of patients with most common arrhythmias. But when misprescribed, through selection of an inappropriate drug or dosage regimen, the end result may range from inadequate control of the arrhythmia to a proarrhythmic effect. Ultimately, the optimal use of antiarrhythmic drug therapy depends in large part on understanding the pharmacodynamics and pharmacokinetics of each antiarrhythmic drug. Despite the common classification of antiarrhythmic drugs into class I, II, III, or IV, each drug has a unique pharmacological profile and must not be considered interchangeable with other members of its class. Likewise, each patient is unique with respect to the innumerable factors that can alter the pharmacokinetics of an antiarrhythmic drug, including coexisting diseases, concurrent drug therapies, and endogenous or age-related metabolic variations. This article provides an overview of the key pharmacodynamic and pharmacokinetic characteristics of the major antiarrhythmic drugs in use. It also offers specific examples that may be used to ensure that patients receive the most appropriate therapy.

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Time to first shock and clinical outcome in patients receiving an automatic implantable cardioverter-defibrillator

Cited by 126 publications

References 9 publications

Predictors of Outcome in Patients with Implantable Cardioverter Defibrillators

Predictors of Outcome in Patients with Implantable Cardioverter Defibrillators

Clinical characteristics and outcome of patients with high defibrillation thresholds. A multicenter study.

Pharmacological Effects of Antiarrhythmic Drugs

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