CLINICAL STUDIES
Outcome of patients with nonischemic dilated cardiomyopathy and unexplained syncope treated with an implantable defibrillator
Bradley P. Knight, MDa,
Rajiva Goyal, MDa,
Frank Pelosi, MDa,
Matthew Flemming, MDa,
Laura Horwood, RNa,
Fred Morady, MD, FACCa and
S. Adam Strickberger, MD, FACCa
a Department of Internal Medicine, Division of Cardiology, University of Michigan Medical Center, Ann Arbor, Michigan, USA
Manuscript received July 17, 1998;
revised manuscript received January 22, 1999,
accepted February 12, 1999.
Reprint requests and correspondence: Dr. Bradley P. Knight, University of Michigan Health System, 1500 East Medical Center Drive, B1F245, Ann Arbor, Michigan 48109-0022.
bpk{at}umich.edu
OBJECTIVES
The purpose of this study was to determine the outcome of patients with nonischemic dilated cardiomyopathy, unexplained syncope and a negative electrophysiology test who are treated with an implantable defibrillator.
BACKGROUND
Patients with nonischemic cardiomyopathy and unexplained syncope may be at high risk for sudden cardiac death, and they are sometimes treated with an implantable defibrillator.
METHODS
This study prospectively determined the outcome of 14 consecutive patients who had a nonischemic cardiomyopathy, unexplained syncope and a negative electrophysiology test and who underwent defibrillator implantation (Syncope Group). Nineteen consecutive patients with a nonischemic cardiomyopathy and a cardiac arrest who were treated with a defibrillator (Arrest Group) served as a control group.
RESULTS
Seven of 14 patients (50%) in the Syncope Group received appropriate shocks for ventricular arrhythmias during a mean follow-up of 24 ± 13 months, compared with 8 of 19 patients (42%) in the Arrest Group during a mean follow-up of 45 ± 40 months (p = 0.1). The mean duration from device implantation until the first appropriate shock was 32 ± 7 months (95% confidence interval [CI], 18 to 45 months) in the Syncope Group compared to 72 ± 12 months (95% CI, 48 to 96 months) in the Arrest Group (p = 0.1). Among patients who received appropriate shocks, the mean time from defibrillator implantation to the first appropriate shock was 10 ± 14 months in the Syncope Group, compared with 48 ± 47 months in the Arrest Group (p = 0.06). Recurrent syncope was always associated with ventricular tachyarrhythmias.
CONCLUSIONS
The high incidence of appropriate defibrillator shocks and the association of recurrent syncope with ventricular arrhythmias support the treatment of patients with nonischemic cardiomyopathy, unexplained syncope and a negative electrophysiology test with an implantable defibrillator.
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Abbreviations and Acronyms
| | NICM | = nonischemic dilated cardiomyopathy | | NYHA | = New York Heart Association |
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