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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117(21):
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9(suppl_I):
I59 - I65.
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|
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|
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|
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47(8):
1507 - 1517.
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|
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February 14, 2006;
113(6):
776 - 782.
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|
|
|
|
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|
|
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J. Am. Coll. Cardiol.,
January 17, 2006;
47(2):
473 - 484.
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|
|
|
|
|
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|
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113(2):
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|
|
|
|
|
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Syncope following cardioverter defibrillator implantation in patients with spontaneous syncopal monomorphic ventricular tachycardia
Eur. Heart J.,
January 1, 2006;
27(1):
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|
|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
|
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JAMA,
December 15, 2004;
292(23):
2874 - 2879.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Brembilla-Perrot, C. Suty-Selton, D. Beurrier, P. Houriez, M. Nippert, A. Terrier de la Chaise, P. Louis, O. Claudon, M. Andronache, A. Abdelaah, et al.
Differences in mechanisms and outcomes of syncope in patients with coronary disease or idiopathic left ventricular dysfunction as assessed by electrophysiologic testing
J. Am. Coll. Cardiol.,
August 4, 2004;
44(3):
594 - 601.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Zecchin, A. Di Lenarda, A. Proclemer, G. Faganello, D. Facchin, E. Petz, and G. Sinagra
The role of implantable cardioverter defibrillator for primary vs secondary prevention of sudden death in patients with idiopathic dilated cardiomyopathy
Europace,
January 1, 2004;
6(5):
400 - 406.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
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Europace,
January 1, 2004;
6(6):
467 - 537.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. H. Hohnloser, T. Klingenheben, D. Bloomfield, O. Dabbous, and R. J. Cohen
Usefulness of microvolt T-wave alternans for prediction of ventricular tachyarrhythmic events in patients with dilated cardiomyopathy: results from a prospective observational study
J. Am. Coll. Cardiol.,
June 18, 2003;
41(12):
2220 - 2224.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. V. Jayachandran and D. P. Zipes
Say no to primary prophylaxis with implantable cardioverter-defibrillators in asymptomatic nonischemic dilated cardiomyopathy?
J. Am. Coll. Cardiol.,
May 21, 2003;
41(10):
1713 - 1715.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Garcia-Civera, R. Ruiz-Granell, S. Morell-Cabedo, R. Sanjuan-Manez, F. Perez-Alcala, E. Plancha, A. Navarro, S. Botella, and A. LLacer
Selective use of diagnostic tests inpatients with syncope of unknown cause
J. Am. Coll. Cardiol.,
March 5, 2003;
41(5):
787 - 790.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Pezawas, G. Stix, J. Kastner, M. Wolzt, C. Mayer, D. Moertl, and H. Schmidinger
Unexplained syncope in patients with structural heart disease and no documented ventricular arrhythmias: value of electrophysiologically guided implantablecardioverter defibrillator therapy
Europace,
January 1, 2003;
5(3):
305 - 312.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Menozzi, M. Brignole, R. Garcia-Civera, A. Moya, G. Botto, L. Tercedor, R. Migliorini, X. Navarro, and on behalf of the International Study on Syncope of
Mechanism of Syncope in Patients With Heart Disease and Negative Electrophysiologic Test
Circulation,
June 11, 2002;
105(23):
2741 - 2745.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Grimm, J.u. Hoffmann, H.-H. Muller, and B. Maisch
Implantable defibrillator event rates in patients with idiopathic dilated cardiomyopathy, nonsustained ventricular tachycardia on Holter and a left ventricular ejection fraction below 30%
J. Am. Coll. Cardiol.,
March 6, 2002;
39(5):
780 - 787.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. G. Priori, E. Aliot, C. Blomstrom-Lundqvist, L. Bossaert, G. Breithardt, P. Brugada, J. A. Camm, R. Cappato, S. M. Cobbe, C. Di Mario, et al.
TASK FORCE ON SUDDEN CARDIAC DEATH, EUROPEAN SOCIETY OF CARDIOLOGY: Summary of Recommendations
Europace,
January 1, 2002;
4(1):
3 - 18.
[Abstract]
[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]
|
|
|
|
|
|
|
S. Mittal, S. C. Hao, S. Iwai, K. M. Stein, S. M. Markowitz, D. J. Slotwiner, and B. B. Lerman
Significance of inducible ventricular fibrillation in patients with coronary artery disease and unexplained syncope
J. Am. Coll. Cardiol.,
August 1, 2001;
38(2):
371 - 376.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Task Force on Syncope, European Society of Cardiol, M Brignole, P Alboni, D Benditt, L Bergfeldt, J.J Blanc, P.E Bloch Thomsen, J.G van Dijk, A Fitzpatrick, S Hohnloser, et al.
Guidelines on management (diagnosis and treatment) of syncope
Eur. Heart J.,
August 1, 2001;
22(15):
1256 - 1306.
[Abstract]
[PDF]
|
|
|
|
|
|
|
G. Gronefeld and S. H Hohnloser
What do implantable cardioverter/defibrillators teach us about the mechanisms of sudden cardiac death?
Cardiovasc Res,
May 1, 2001;
50(2):
232 - 241.
[Abstract]
[Full Text]
[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]
|
|
|
|
|
|
|
S.H. Hohnloser
Electrocardiographic risk stratification in dilative cardiomyopathy: an unfulfilled promise
Eur. Heart J.,
June 2, 2000;
21(12):
953 - 954.
[PDF]
|
|
|
|
|
|
|
Consider an Implantable Defibrillator for Nonischemic Cardiomyopathy with Unexplained Syncope
Journal Watch Cardiology,
August 20, 1999;
1999(820):
3 - 3.
[Full Text]
|
|
|
|
