Efficacy of the automatic implantable cardioverter-defibrillator in prolonging survival in patients with severe underlying cardiac disease
RN Fogoros,
JJ Elson,
CA Bonnet,
SB Fiedler,
and
JA Burkholder
Division of Cardiology, Medical College of Pennsylvania, Pittsburgh.
The ability of the automatic implantable cardioverter-defibrillator to prolong overall survival, particularly in patients with significantly depressed cardiac function, has not been well documented. Of 119 patients who received the implantable defibrillator in this institution, 40 had a left ventricular ejection fraction less than 30% (Group A) and 79 had an ejection fraction greater than or equal to 30% (Group B). For each group, cumulative survival was compared with the projected survival if the implantable defibrillator had not been used. Projected survival was based on the assumption that the first appropriate shock would have resulted in death without the defibrillator. For Group A, the 3 year cumulative survival rate was 67 +/- 12% versus a projected survival rate of 6 +/- 15% (p less than 0.001). For Group B, the 3 year cumulative survival rate was 96 +/- 3% versus a projected survival rate of 46 +/- 8% (p less than 0.001). Both the cumulative and projected survival rates for patients in Group A were significantly worse than for patients in Group B (p less than 0.01). The projected survival rates for both Groups A and B were comparable with the observed survival rate in similar patients treated without the implantable defibrillator. In summary, the implantable cardioverter-defibrillator significantly prolonged overall survival, even in patients with poor cardiac function. The technique of estimating projected survival appears to allow a realistic estimate of the reduction in mortality achieved by the defibrillator.
This article has been cited by other articles:
|
|
|
|
 
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al.
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
May 27, 2008;
51(21):
e1 - e62.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Epstein, J. P. DiMarco, K. A. Ellenbogen, N.A. M. Estes III, R. A. Freedman, L. S. Gettes, A. M. Gillinov, G. Gregoratos, S. C. Hammill, D. L. Hayes, et al.
ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): Developed in Collaboration With the American Association for Thoracic Surgery and Society of Thoracic Surgeons
Circulation,
May 27, 2008;
117(21):
e350 - e408.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Cappato, S. Boczor, K.-H. Kuck, and on behalf of the CASH Investigators
Response to programmed ventricular stimulation and clinical outcome in cardiac arrest survivors receiving randomised assignment to implantable cardioverter defibrillator or antiarrhythmic drug therapy
Eur. Heart J.,
April 2, 2004;
25(8):
642 - 649.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Committee Members, G. Gregoratos, J. Abrams, A. E. Epstein, R. A. Freedman, D. L. Hayes, M. A. Hlatky, R. E. Kerber, G. V. Naccarelli, M. H. Schoenfeld, et al.
ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines)
J. Am. Coll. Cardiol.,
November 6, 2002;
40(9):
1703 - 1719.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Gregoratos, J. Abrams, A. E. Epstein, R. A. Freedman, D. L. Hayes, M. A. Hlatky, R. E. Kerber, G. V. Naccarelli, M. H. Schoenfeld, M. J. Silka, et al.
ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices: Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/NASPE Committee to Update the 1998 Pacemaker Guidelines)
Circulation,
October 15, 2002;
106(16):
2145 - 2161.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. B. Mitchell, E. A. Pineda, J. L. Titus, P. M. Bartosch, and D. G. Benditt
Sudden death in patients with implantable cardioverter defibrillators: The importance of post-shock electromechanical dissociation
J. Am. Coll. Cardiol.,
April 17, 2002;
39(8):
1323 - 1328.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. E. Sandner, G. Wieselthaler, A. Zuckermann, S. Taghavi, H. Schmidinger, R. Pacher, M. Ploner, G. Laufer, E. Wolner, and M. Grimm
Survival Benefit of the Implantable Cardioverter-Defibrillator in Patients on the Waiting List for Cardiac Transplantation
Circulation,
September 18, 2001;
104
(2009):
I-171 - I-176.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S.G. Priori, E. Aliot, C. Blomstrom-Lundqvist, L. Bossaert, G. Breithardt, P. Brugada, A.J. Camm, R. Cappato, S.M. Cobbe, C. Di Mario, et al.
Task Force on Sudden Cardiac Death of the European Society of Cardiology
Eur. Heart J.,
August 2, 2001;
22(16):
1374 - 1450.
[PDF]
|
|
|
|
|
|
|
M. E. Josephson, D. J. Callans, and A. E. Buxton
The Role of the Implantable Cardioverter-Defibrillator for Prevention of Sudden Cardiac Death
Ann Intern Med,
December 5, 2000;
133(11):
901 - 910.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K.-H. Kuck, R. Cappato, J. Siebels, and R. Ruppel
Randomized Comparison of Antiarrhythmic Drug Therapy With Implantable Defibrillators in Patients Resuscitated From Cardiac Arrest : The Cardiac Arrest Study Hamburg (CASH)
Circulation,
August 15, 2000;
102(7):
748 - 754.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
The AVID Investigators
Causes of death in the antiarrhythmics versus implantable defibrillators (AVID) trial
J. Am. Coll. Cardiol.,
November 1, 1999;
34(5):
1552 - 1559.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Ruppel, C. A. Schluter, S. Boczor, T. Meinertz, M. Schluter, K.-H. Kuck, and R. Cappato
Ventricular tachycardia during follow-up in patients resuscitated from ventricular fibrillation: experience from stored electrograms of implantable cardioverter-defibrillators
J. Am. Coll. Cardiol.,
November 15, 1998;
32(6):
1724 - 1730.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Bocker, D. Bansch, A. Heinecke, M. Weber, J. Brunn, D. Hammel, M. Borggrefe, G. Breithardt, and M. Block
Potential Benefit From Implantable Cardioverter-Defibrillator Therapy in Patients With and Without Heart Failure
Circulation,
October 20, 1998;
98(16):
1636 - 1643.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Yamanouchi, K. A. Mowrey, M. J. Niebauer, P. J. Tchou, and B. L. Wilkoff
Additional Lead Improves Defibrillation Efficacy With an Abdominal `Hot Can' Electrode System
Circulation,
December 16, 1997;
96(12):
4400 - 4407.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
G. Gioia, B. Bagheri, C. D. Gottlieb, D. S. Schwartzman, D. J. Callans, F. E. Marchlinski, J. Heo, and A. E. Iskandrian
Prediction of Outcome of Patients With Life-Threatening Ventricular Arrhythmias Treated With Automatic Implantable Cardioverter-Defibrillators Using SPECT Perfusion Imaging
Circulation,
January 21, 1997;
95(2):
390 - 394.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
G. J. Fahy, E. B. Sgarbossa, P. J. Tchou, and S. L. Pinski
Hospital Readmission in Patients Treated With Tiered-Therapy Implantable Defibrillators
Circulation,
September 15, 1996;
94(6):
1350 - 1356.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
D. Bocker, W. Haverkamp, M. Block, M. Borggrefe, D. Hammel, and G. Breithardt
Comparison of d,l-Sotalol and Implantable Defibrillators for Treatment of Sustained Ventricular Tachycardia or Fibrillation in Patients With Coronary Artery Disease
Circulation,
July 15, 1996;
94(2):
151 - 157.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
J. Villacastin, J. Almendral, A. Arenal, J. Albertos, J. Ormaetxe, R. Peinado, H. Bueno, J. L. Merino, A. Pastor, O. Medina, et al.
Incidence and Clinical Significance of Multiple Consecutive, Appropriate, High-Energy Discharges in Patients With Implanted Cardioverter-Defibrillators
Circulation,
February 15, 1996;
93(4):
753 - 762.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
E. F.D. Wever, R. N.W. Hauer, G. Schrijvers, F. J.L. van Capelle, J. G.P. Tijssen, H. J.G.M. Crijns, A. Algra, H. Ramanna, P. F.A. Bakker, and E. O. Robles de Medina
Cost-effectiveness of Implantable Defibrillator as First-Choice Therapy Versus Electrophysiologically Guided, Tiered Strategy in Postinfarct Sudden Death Survivors : A Randomized Study
Circulation,
February 1, 1996;
93(3):
489 - 496.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
M. R. Costanzo, S. Augustine, R. Bourge, M. Bristow, J. B. O'Connell, D. Driscoll, and E. Rose
Selection and Treatment of Candidates for Heart Transplantation : A Statement for Health Professionals From the Committee on Heart Failure and Cardiac Transplantation of the Council on Clinical Cardiology, American Heart Association
Circulation,
December 15, 1995;
92(12):
3593 - 3612.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
M. O. Sweeney, J. N. Ruskin, H. Garan, B. A. McGovern, M. L. Guy, D. F. Torchiana, G. J. Vlahakes, J. B. Newell, M. J. Semigran, and G. W. Dec
Influence of the Implantable Cardioverter/Defibrillator on Sudden Death and Total Mortality in Patients Evaluated for Cardiac Transplantation
Circulation,
December 1, 1995;
92(11):
3273 - 3281.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
E. U. Alt, P. C. Fotuhi, R. L. Callihan, E. Mestre, W. M. Smith, and R. E. Ideker
Endocardial Carbon-Braid Electrodes : A New Concept for Lower Defibrillation Thresholds
Circulation,
September 15, 1995;
92(6):
1627 - 1633.
[Abstract]
[Full Text]
|
|
|
|
