Do patients with an implantable defibrillator live longer?

Department of Cardiology and Angiology, Westfalische-Wilhelms-Universitat, Munster, Germany.

OBJECTIVES. This study was done to provide information on the potential benefit of implantable cardioverter-defibrillator therapy regarding sudden and arrhythmia-related deaths and to examine whether such therapy improves survival. BACKGROUND. Implantation of automatic cardioverter-defibrillators is reported to abort sudden cardiac death due to malignant tachyarrhythmias. METHODS. Between 1989 and 1992, 107 patients were screened for implantation of a third-generation implantable cardioverter-defibrillator combined with endocardial leads. Mean age was 57 +/- 13 years and mean ejection fraction was 40 +/- 15%. Sudden death, total arrhythmia-related death and total cardiac death were compared with the occurrence of fast ventricular tachyarrhythmias (> 240 beats/min), assuming that most of these arrhythmias would have been fatal without treatment by the implantable cardioverter-defibrillator. RESULTS. The surgical mortality rate was 2.7% in all 107 patients and 1% in the 99 patients who qualified for endocardial leads. During a follow-up period of 12 +/- 8 months, actuarial survival rate free of events at 6 months as well as at 12 and 18 months was 100% for sudden death, 97% for total arrhythmia-related death and 95% for total cardiac death. In contrast, after 6, 12 and 18 months, the rate of survival free of fast ventricular tachycardia was only 83%, 74% and 69%, respectively, and the rate of survival free of any ventricular tachyarrhythmia was only 59%, 49% and 40%, respectively. CONCLUSIONS. The outcome of patients treated with an implantable cardioverter-defibrillator and endocardial defibrillation leads is excellent. For many patients, this treatment is probably lifesaving.

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