Comparison of defibrillator therapy and other therapeutic modalities for sustained ventricular tachycardia or ventricular fibrillation associated with coronary artery disease

Chung Whee Choue, Soo G. Kim, John Devens Fisher, James A. Roth, Kevin J. Ferrick, Richard Brodman, Rosemary Frame, Jay N. Gross, Seymour Furman

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Outcomes of 282 patients referred to the arrhythmia service at Montefiore Medical Center for sustained ventricular tachycardia (n = 214) or ventricular fibrillation (n = 68) associated with coronary artery disease were analyzed retrospectively. All patients underwent serial drug trials by electrophysiologic testing and Holter monitoring. Sixty-eight patients who did not respond to drug therapy were treated with implantable cardioverter-defibrillators (ICD group), and 214 patients were treated with other methods guided by electrophysiologic testing and Holter monitoring (non-ICD group). The non-ICD group included 49 patients who responded to drug therapy as judged by electrophysiologic testing, as well as patients who did not respond and were not treated with defibrillator therapy for various reasons. Ten patients died in the hospital (2 patients in the ICD group, 8 in the non-ICD group). Actuarial survival rates free of total cardiac death at 1, 2, and 3 years were, respectively, 94%, 87%, and 85% in the ICD group, and 82%, 78%, and 73% in the non-ICD group (p = NS). Survival rates free of total death at 1, 2, and 3 years were 90%, 82%, and 76% in the ICD group, and 82%, 76%, and 70% in the non-ICD group, respectively (p = NS). Survival rates free of total cardiac and total deaths of 49 patients treated with an effective regimen determined by electrophysiologic testing were not significantly different from those of the ICD group. This retrospective study suggests that outcomes of patients treated with ICDs may not be dramatically different from those of patients treated with other methods guided primarily by electrophysiologic testing. Therefore, prospective studies comparing ICD therapy with drug therapies are ethically justified and should be conducted to determine roles of various therapeutic procedures.

Original languageEnglish (US)
Pages (from-to)1075-1079
Number of pages5
JournalThe American Journal of Cardiology
Volume73
Issue number15
DOIs
StatePublished - Jun 1 1994

Fingerprint

Defibrillators
Ventricular Fibrillation
Ventricular Tachycardia
Coronary Artery Disease
Therapeutics
Ambulatory Electrocardiography
Survival Rate
Drug Therapy
Implantable Defibrillators
Cardiac Arrhythmias
Retrospective Studies
Prospective Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of defibrillator therapy and other therapeutic modalities for sustained ventricular tachycardia or ventricular fibrillation associated with coronary artery disease. / Choue, Chung Whee; Kim, Soo G.; Fisher, John Devens; Roth, James A.; Ferrick, Kevin J.; Brodman, Richard; Frame, Rosemary; Gross, Jay N.; Furman, Seymour.

In: The American Journal of Cardiology, Vol. 73, No. 15, 01.06.1994, p. 1075-1079.

Research output: Contribution to journalArticle

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abstract = "Outcomes of 282 patients referred to the arrhythmia service at Montefiore Medical Center for sustained ventricular tachycardia (n = 214) or ventricular fibrillation (n = 68) associated with coronary artery disease were analyzed retrospectively. All patients underwent serial drug trials by electrophysiologic testing and Holter monitoring. Sixty-eight patients who did not respond to drug therapy were treated with implantable cardioverter-defibrillators (ICD group), and 214 patients were treated with other methods guided by electrophysiologic testing and Holter monitoring (non-ICD group). The non-ICD group included 49 patients who responded to drug therapy as judged by electrophysiologic testing, as well as patients who did not respond and were not treated with defibrillator therapy for various reasons. Ten patients died in the hospital (2 patients in the ICD group, 8 in the non-ICD group). Actuarial survival rates free of total cardiac death at 1, 2, and 3 years were, respectively, 94{\%}, 87{\%}, and 85{\%} in the ICD group, and 82{\%}, 78{\%}, and 73{\%} in the non-ICD group (p = NS). Survival rates free of total death at 1, 2, and 3 years were 90{\%}, 82{\%}, and 76{\%} in the ICD group, and 82{\%}, 76{\%}, and 70{\%} in the non-ICD group, respectively (p = NS). Survival rates free of total cardiac and total deaths of 49 patients treated with an effective regimen determined by electrophysiologic testing were not significantly different from those of the ICD group. This retrospective study suggests that outcomes of patients treated with ICDs may not be dramatically different from those of patients treated with other methods guided primarily by electrophysiologic testing. Therefore, prospective studies comparing ICD therapy with drug therapies are ethically justified and should be conducted to determine roles of various therapeutic procedures.",
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