Influence of left ventricular function on outcome of patients treated with implantable defibrillators

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

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Abstract

Background. The outcomes of patients treated with implantable defibrillators were compared between patients with left ventricular ejection fraction ≥30% and <30%. Methods and Results. Of 68 consecutive patients treated with implantable defibrillators, 40 patients (group 1) had left ventricular ejection fraction ≥30%, and 28 patients (group 2) had left ventricular ejection fraction <30%. Sudden death, surgical mortality, nonsudden arrhythmia-related death (death within 24 hours after an arrhythmic event despite initial termination of the arrhythmia by the implantable defibrillator), total arrhythmia-related death (including sudden death, surgical death, and nonsudden arrhythmia-related death), and total cardiac death were compared between the two groups. Surgical mortality was 4.4% (0% in group 1, 11% in group 2). During the follow-up of 31±27 months, actuarial survival rates free of events were 97%, 97%, and 97% in group 1 and 96%, 91%, and 82% in group 2 at 12, 24, and 36 months, respectively, for sudden death (p=NS); 97%, 97%, and 97% in group 1 and 85%, 81%, and 72% in group 2 at 12, 24, and 36 months, respectively, for sudden death and surgical mortality (p<0.05); 97%, 97%, and 97% in group 1 and 82%, 78%, and 70% in group 2 at 12, 24, and 36 months, respectively, for total arrhythmia-related death (p<0.05); and 95%, 95%, and 95% in group 1 and 82%, 69%, and 57% in group 2 at 12, 24, and 36 months, respectively, for total cardiac death (p<0.05). Four (57%) of seven nonsudden cardiac deaths during the initial 36-month follow-up period were causally related to arrhythmia (three surgical deaths and one arrhythmia-related nonsudden death). Conclusions. The outcome of patients treated with implantable defibrillators is strongly influenced by the degree of left ventricular dysfunction. In group 1 patients, surgical mortality, sudden death, and total cardiac death are rare. In group 2, sudden death rate may not be markedly different from that of group 1 patients. However, the risk of therapy (surgical mortality) is high. Many nonsudden cardiac deaths are causally related to arrhythmia (surgical mortality or nonsudden arrhythmia-related death). Therefore, the survival rate free of total arrhythmia-related death is significantly lower in group 2 (70% versus 97% in group 1 at 3 years). Further studies are needed to determine the roles of defibrillator therapy and other therapies in various clinical settings.

Original languageEnglish (US)
Pages (from-to)1304-1310
Number of pages7
JournalCirculation
Volume85
Issue number4
StatePublished - Apr 1992

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Implantable Defibrillators
Left Ventricular Function
Cardiac Arrhythmias
Sudden Death
Mortality
Stroke Volume
Survival Rate
Defibrillators
Left Ventricular Dysfunction

Keywords

  • Implantable defibrillators
  • Sudden death
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Influence of left ventricular function on outcome of patients treated with implantable defibrillators. / Kim, Soo G.; Fisher, John Devens; Choue, Chung Whee; Gross, Jay N.; Roth, James; Ferrick, Kevin J.; Brodman, Richard; Furman, Seymour.

In: Circulation, Vol. 85, No. 4, 04.1992, p. 1304-1310.

Research output: Contribution to journalArticle

@article{16c250add91c4b2a8dcbac4e65f9a1cd,
title = "Influence of left ventricular function on outcome of patients treated with implantable defibrillators",
abstract = "Background. The outcomes of patients treated with implantable defibrillators were compared between patients with left ventricular ejection fraction ≥30{\%} and <30{\%}. Methods and Results. Of 68 consecutive patients treated with implantable defibrillators, 40 patients (group 1) had left ventricular ejection fraction ≥30{\%}, and 28 patients (group 2) had left ventricular ejection fraction <30{\%}. Sudden death, surgical mortality, nonsudden arrhythmia-related death (death within 24 hours after an arrhythmic event despite initial termination of the arrhythmia by the implantable defibrillator), total arrhythmia-related death (including sudden death, surgical death, and nonsudden arrhythmia-related death), and total cardiac death were compared between the two groups. Surgical mortality was 4.4{\%} (0{\%} in group 1, 11{\%} in group 2). During the follow-up of 31±27 months, actuarial survival rates free of events were 97{\%}, 97{\%}, and 97{\%} in group 1 and 96{\%}, 91{\%}, and 82{\%} in group 2 at 12, 24, and 36 months, respectively, for sudden death (p=NS); 97{\%}, 97{\%}, and 97{\%} in group 1 and 85{\%}, 81{\%}, and 72{\%} in group 2 at 12, 24, and 36 months, respectively, for sudden death and surgical mortality (p<0.05); 97{\%}, 97{\%}, and 97{\%} in group 1 and 82{\%}, 78{\%}, and 70{\%} in group 2 at 12, 24, and 36 months, respectively, for total arrhythmia-related death (p<0.05); and 95{\%}, 95{\%}, and 95{\%} in group 1 and 82{\%}, 69{\%}, and 57{\%} in group 2 at 12, 24, and 36 months, respectively, for total cardiac death (p<0.05). Four (57{\%}) of seven nonsudden cardiac deaths during the initial 36-month follow-up period were causally related to arrhythmia (three surgical deaths and one arrhythmia-related nonsudden death). Conclusions. The outcome of patients treated with implantable defibrillators is strongly influenced by the degree of left ventricular dysfunction. In group 1 patients, surgical mortality, sudden death, and total cardiac death are rare. In group 2, sudden death rate may not be markedly different from that of group 1 patients. However, the risk of therapy (surgical mortality) is high. Many nonsudden cardiac deaths are causally related to arrhythmia (surgical mortality or nonsudden arrhythmia-related death). Therefore, the survival rate free of total arrhythmia-related death is significantly lower in group 2 (70{\%} versus 97{\%} in group 1 at 3 years). Further studies are needed to determine the roles of defibrillator therapy and other therapies in various clinical settings.",
keywords = "Implantable defibrillators, Sudden death, Ventricular fibrillation",
author = "Kim, {Soo G.} and Fisher, {John Devens} and Choue, {Chung Whee} and Gross, {Jay N.} and James Roth and Ferrick, {Kevin J.} and Richard Brodman and Seymour Furman",
year = "1992",
month = "4",
language = "English (US)",
volume = "85",
pages = "1304--1310",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
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T1 - Influence of left ventricular function on outcome of patients treated with implantable defibrillators

AU - Kim, Soo G.

AU - Fisher, John Devens

AU - Choue, Chung Whee

AU - Gross, Jay N.

AU - Roth, James

AU - Ferrick, Kevin J.

AU - Brodman, Richard

AU - Furman, Seymour

PY - 1992/4

Y1 - 1992/4

N2 - Background. The outcomes of patients treated with implantable defibrillators were compared between patients with left ventricular ejection fraction ≥30% and <30%. Methods and Results. Of 68 consecutive patients treated with implantable defibrillators, 40 patients (group 1) had left ventricular ejection fraction ≥30%, and 28 patients (group 2) had left ventricular ejection fraction <30%. Sudden death, surgical mortality, nonsudden arrhythmia-related death (death within 24 hours after an arrhythmic event despite initial termination of the arrhythmia by the implantable defibrillator), total arrhythmia-related death (including sudden death, surgical death, and nonsudden arrhythmia-related death), and total cardiac death were compared between the two groups. Surgical mortality was 4.4% (0% in group 1, 11% in group 2). During the follow-up of 31±27 months, actuarial survival rates free of events were 97%, 97%, and 97% in group 1 and 96%, 91%, and 82% in group 2 at 12, 24, and 36 months, respectively, for sudden death (p=NS); 97%, 97%, and 97% in group 1 and 85%, 81%, and 72% in group 2 at 12, 24, and 36 months, respectively, for sudden death and surgical mortality (p<0.05); 97%, 97%, and 97% in group 1 and 82%, 78%, and 70% in group 2 at 12, 24, and 36 months, respectively, for total arrhythmia-related death (p<0.05); and 95%, 95%, and 95% in group 1 and 82%, 69%, and 57% in group 2 at 12, 24, and 36 months, respectively, for total cardiac death (p<0.05). Four (57%) of seven nonsudden cardiac deaths during the initial 36-month follow-up period were causally related to arrhythmia (three surgical deaths and one arrhythmia-related nonsudden death). Conclusions. The outcome of patients treated with implantable defibrillators is strongly influenced by the degree of left ventricular dysfunction. In group 1 patients, surgical mortality, sudden death, and total cardiac death are rare. In group 2, sudden death rate may not be markedly different from that of group 1 patients. However, the risk of therapy (surgical mortality) is high. Many nonsudden cardiac deaths are causally related to arrhythmia (surgical mortality or nonsudden arrhythmia-related death). Therefore, the survival rate free of total arrhythmia-related death is significantly lower in group 2 (70% versus 97% in group 1 at 3 years). Further studies are needed to determine the roles of defibrillator therapy and other therapies in various clinical settings.

AB - Background. The outcomes of patients treated with implantable defibrillators were compared between patients with left ventricular ejection fraction ≥30% and <30%. Methods and Results. Of 68 consecutive patients treated with implantable defibrillators, 40 patients (group 1) had left ventricular ejection fraction ≥30%, and 28 patients (group 2) had left ventricular ejection fraction <30%. Sudden death, surgical mortality, nonsudden arrhythmia-related death (death within 24 hours after an arrhythmic event despite initial termination of the arrhythmia by the implantable defibrillator), total arrhythmia-related death (including sudden death, surgical death, and nonsudden arrhythmia-related death), and total cardiac death were compared between the two groups. Surgical mortality was 4.4% (0% in group 1, 11% in group 2). During the follow-up of 31±27 months, actuarial survival rates free of events were 97%, 97%, and 97% in group 1 and 96%, 91%, and 82% in group 2 at 12, 24, and 36 months, respectively, for sudden death (p=NS); 97%, 97%, and 97% in group 1 and 85%, 81%, and 72% in group 2 at 12, 24, and 36 months, respectively, for sudden death and surgical mortality (p<0.05); 97%, 97%, and 97% in group 1 and 82%, 78%, and 70% in group 2 at 12, 24, and 36 months, respectively, for total arrhythmia-related death (p<0.05); and 95%, 95%, and 95% in group 1 and 82%, 69%, and 57% in group 2 at 12, 24, and 36 months, respectively, for total cardiac death (p<0.05). Four (57%) of seven nonsudden cardiac deaths during the initial 36-month follow-up period were causally related to arrhythmia (three surgical deaths and one arrhythmia-related nonsudden death). Conclusions. The outcome of patients treated with implantable defibrillators is strongly influenced by the degree of left ventricular dysfunction. In group 1 patients, surgical mortality, sudden death, and total cardiac death are rare. In group 2, sudden death rate may not be markedly different from that of group 1 patients. However, the risk of therapy (surgical mortality) is high. Many nonsudden cardiac deaths are causally related to arrhythmia (surgical mortality or nonsudden arrhythmia-related death). Therefore, the survival rate free of total arrhythmia-related death is significantly lower in group 2 (70% versus 97% in group 1 at 3 years). Further studies are needed to determine the roles of defibrillator therapy and other therapies in various clinical settings.

KW - Implantable defibrillators

KW - Sudden death

KW - Ventricular fibrillation

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VL - 85

SP - 1304

EP - 1310

JO - Circulation

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