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Appropriate therapies predict long-term mortality in primary and secondary prevention of sudden cardiac death

2012; Lippincott Williams & Wilkins; Volume: 14; Issue: 2 Linguagem: Inglês

10.2459/jcm.0b013e3283511f5b

1558-2035

Giuseppe Stabile, Carlo D’Agostino, Paolo Gallo, Natale Marrazzo, Assunta Iuliano, Antonio De Simone, Pietro Turco, Michele Palella, Giovanni Donnici, Carmine Ciardiello, Giovanni Napolitano, Francesco Solimene,

Cardiac Arrhythmias and Treatments

Less than 50% of patients implanted with an implantable cardioverter-defibrillator (ICD) receive device therapy during the follow-up. The aim of our study was to prospectively evaluate the predictive role of appropriate ICD therapy on long-term survival of patients implanted for primary or secondary sudden death prevention.From 2002 to 2003, 139 consecutive patients [mean age 66±9 years, male 77%, ischemic heart disease 56%, New York Heart Association functional class >II (74%), primary prevention 74%, mean left ventricular ejection fraction 30±9%, cardiac resynchronization ICD 65%] were enrolled. We collected and evaluated device therapies for at least 18 months and recorded survival status for more than 5 years.Over a median follow-up of 18 months, 54 (39%) patients received at least one ICD intervention, with 28 patients receiving only appropriate ICD therapies, 13 only inappropriate therapies and 13 receiving both therapies. At a mean follow-up of 63±12 months, 30 deaths occurred in 130 patients (23%); for nine patients, we had no survival status information. Death was classified as cardiac in 22 (73%) patients, the most common cause was progressive heart failure. In a Cox proportional regression model, an appropriate ICD therapy was associated with a significant increase in the subsequent risk of death (hazard ratio 3.02, P=0.003).In patients implanted with ICD or cardiac resynchronization therapy with ICD devices, for primary or secondary sudden cardiac death prevention, appropriate ICD therapy predicts a three-fold greater risk of death.