Document Detail


Sudden death in recipients of first-generation implantable cardioverter defibrillators: analysis of terminal events. Participating investigators.
MedLine Citation:
PMID:  10155197     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Clinical factors and terminal events associated with sudden death in 51 patients were analyzed from among a multicenter experience of 864 recipients of first generation automatic implantable cardioverter defibrillator (AICD) devices (single zone, committed, monophasic pulse with > or = 1 epicardial patch electrode) during the period May 1982-February 1988. For these 51 patients, mean age was 58 years and atherosclerotic heart disease was present in 84%, with a history of ventricular fibrillation (VF) in 61%, and inducible sustained ventricular tachycardia (VT) in 84%; mean left ventricular ejection fraction was 0.26. Nearly 80% experienced one or more appropriate AICD shocks during the median 9 month (range 0-46 months) period prior to death. Of 30 monitored deaths, the first documented terminal rhythm was VF in 12 (40%), VT in 8 (27%), and asystole or electromechanical dissociation in the remaining 10 (33%). Shocks were documented during terminal events in 21 (66%) of 32 witnessed cases of sudden death with activated devices. The proportion of monitored or witnessed sudden deaths that were known or presumed to be tachyarrhythmic (based on terminal VT, VF, or shocks) ranged from 69% (11/16 cases with activated/nondepleted devices and a defibrillation threshold [DFT] < or = 20 J) to 81% (29/36 cases on intention-to-treat basis). Of 27 patients with known or presumed sudden tachyarrhythmic death, the AICD had been deactivated prior to death in 4 (15%); activated, but depleted in 4 (15%); activated/nondepleted, but with DFT of 25 J in 4 (15%); and activated/nondepleted, but without DFT testing in 4 (15%). The remaining 11 (41%) known or presumed sudden tachyarrhythmic deaths occurred in patients with activated/nondepleted devices and DFT < or = 20 J; however, definite or suspected contributory factors (e.g., hematoma under epicardial patch, generator component failure, or drug-induced DFT rise) could be identified in 6 (55%) of 11 cases. Thus, in this first-generation AICD experience: 1) most sudden deaths occurred on the basis of a known or presumed tachyarrhythmia; and 2) an understanding of apparent "failure" of ICD therapy could often be gained through an integrated analysis of associated clinical factors and management practices, as well as device "hardware" function. These observations are likely to remain relevant, even with respect to newer generation ICDs.
Authors:
M H Lehmann; A Thomas; M Nabih; R T Steinman; B S Fromm; M Shah; S W Norsted
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Publication Detail:
Type:  Journal Article; Multicenter Study; Review    
Journal Detail:
Title:  Journal of interventional cardiology     Volume:  7     ISSN:  0896-4327     ISO Abbreviation:  J Interv Cardiol     Publication Date:  1994 Oct 
Date Detail:
Created Date:  1995-11-07     Completed Date:  1995-11-07     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8907826     Medline TA:  J Interv Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  487-503     Citation Subset:  T    
Affiliation:
Division of Cardiology/Department of Medicine, Harper Hospital, Wayne State University School of Medicine, Detroit, MI, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cause of Death
Child
Death, Sudden, Cardiac / epidemiology*
Defibrillators, Implantable* / adverse effects
Equipment Failure
Female
Humans
Incidence
Longitudinal Studies
Male
Middle Aged
Survival Analysis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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