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Sudden Death in Recipients of Transvenous Implantable Cardioverter Defibrillator Systems:
Author(s) -
PIRES LUIS A.,
HULL MICHAEL L.,
NINO CHARLES L.,
MAY LYNETTE M.,
GANJI JAGADEESH R.
Publication year - 1999
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.1999.tb00276.x
Subject(s) - medicine , cardiology , implantable cardioverter defibrillator , ventricular tachycardia , ventricular fibrillation , sudden death , ejection fraction , sudden cardiac death , coronary artery disease , odds ratio , confidence interval , defibrillation , heart failure
Sudden Death in ICD Recipients. Introduction : Transvenous implantable cardioverter defibrillator (ICD) systems are very effective in preventing sudden death; however, little is known about terminal events and potential causes and mechanisms of sudden death in recipients of these devices. Methods and Results : We analyzed 74 cases of sudden death among patients enrolled in several clinical investigations of transvenous ICD systems. Eighty‐one percent were men (mean age 68 ± 10 years), 86% had coronary artery disease, mean left ventricular ejection fraction was 0.27 ± 0.11, and two thirds presented with sustained ventricular tachycardia. The final event was witnessed in 65 patients (81%). Based on reported ICD shocks, documented rhythm, and/or postmortem device data, sudden death was deemed tachyarrhythmic in 49 cases (66%), non‐tachyarrhythmic in 12 (16%), and indeterminate in the remaining 13 (18%). Multivariate analysis of several clinical and nonclinical factors found advanced age (>65 years, P = 0.03, odds ratio [OR] 1.75, 95% confidence interval [CI] 1.05 to 2.92), reduced left ventricular ejection fraction (< 0.35, P < 0.01, OR 3.51, CI 1.66 to 7.40), and having antibradycardia pacing ICDs (P = 0.02, OR 5.26, CI 1.37 to 20.0) to be independent predictors of sudden death. One or more predisposing factors and/or potential causes of sudden death were identified in 21 patients (28%). Conclusion : In this select group of transvenous ICD recipients, (1) sudden death was associated with ventricular tachycardia/ventricular fibrillation in at least two thirds of cases, (2) nearly one third of patients had one or more factors, some device related, that could have been associated with sudden death, and (3) death ensued despite appropriate ICD therapies and, in many cases, external resuscitation, suggesting acute adverse events as common terminal factors.