Influence of implantable cardioverter-defibrillators on the long-term prognosis of survivors of out-of-hospital cardiac arrest

• Published in: Circulation (New York, N.Y.) Vol. 88; no. 3; pp. 1083 - 1092
• Main Authors: POWELL, A. C, FUCHS, T, FINKELSTEIN, D. M, GARAN, H, CANNOM, D. S, MCGOVERN, B. A, KELLY, E, VLAHAKES, G. J, TORCHIANA, D. F, RUSKIN, J. N
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.09.1993
• Subjects: Anti-Arrhythmia Agents - therapeutic use; Biological and medical sciences; Cardiac dysrhythmias; Cardiac Pacing, Artificial; Cardiology. Vascular system; Death, Sudden, Cardiac - epidemiology; Defibrillators, Implantable; Female; Heart; Heart Arrest - mortality; Heart Arrest - therapy; Humans; Male; Medical sciences; Middle Aged; Myocardial Revascularization; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome; Ventricular Function, Left - physiology; Human; Cardiocirculatory arrest; Arrhythmia; Follow up study; Implanted; Sudden death; Electrophysiology; Instrumentation therapy; Cardiovascular disease; Survival; Excitability disorder; Defibrillator
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.88.3.1083

Survivors of out-of-hospital cardiac arrest not associated with acute myocardial infarction are at high risk for recurrent cardiac arrest and sudden cardiac death. The impact of the implantable cardioverter-defibrillator on long-term prognosis in these patients is uncertain. Three hundred thirty-one survivors of out-of-hospital cardiac arrest (age, 56 +/- 13.7 years) underwent electrophysiologically guided therapy. Implantable defibrillators were placed in 150 patients (45.3%), and 181 patients (54.7%) received pharmacological and/or surgical therapy alone. Left ventricular ejection fraction was 35.2 +/- 16.6% in defibrillator recipients and 45.3 +/- 18.2% in nondefibrillator patients. Median patient follow-up was 24 months in the defibrillator group and 46 months in the nondefibrillator group. In a proportional hazards model, the independent predictors of total cardiac mortality were left ventricular ejection fraction of less than 0.40 (relative risk, 4.55; 95% confidence interval, 2.44 to 8.33; P = .0001), absence of an implantable defibrillator (relative risk, 2.70; confidence interval, 1.41 to 5.00; P = .017), and persistence of inducible sustained ventricular tachycardia (relative risk, 1.84; 95% confidence interval, 0.97 to 3.49; P = .045). The 1- and 5-year probabilities of survival free of cardiac mortality in patients with left ventricular ejection fraction of less than 0.40 were 94.3% and 69.6% with a defibrillator and 82.1% and 45.3% without a defibrillator, respectively. For patients with left ventricular ejection fraction of 0.40 or more, the 1- and 5-year probabilities of survival free of cardiac mortality were 97.7% and 94.6% with a defibrillator and 95.4% and 86.9% without a defibrillator, respectively. In survivors of out-of-hospital cardiac arrest, the implantable defibrillator is associated with a reduction in cardiac mortality, particularly in patients with impaired left ventricular function.