CLINICAL STUDY: HEART FAILURE
Implantable defibrillator event rates in patients with idiopathic dilated cardiomyopathy, nonsustained ventricular tachycardia on Holter and a left ventricular ejection fraction below 30%
Wolfram Grimm, MD*,*,
J.ürgen Hoffmann, MD*,
Hans-Helge Müller, PhD and
Bernhard Maisch, MD*
* Department of Cardiology, Hospital of the Philipps-University of Marburg, Marburg, Germany
Medical Center for Methodology and Health Research, Institute for Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany
Manuscript received June 27, 2001;
revised manuscript received October 18, 2001,
accepted December 12, 2001.
* Reprint requests and correspondence: Dr. Wolfram Grimm, Hospital of the Philipps-University Marburg, Department of Cardiology, Baldingerstraße, 35033 Marburg, Germany.
wolfram.grimm{at}med.uni-marburg.de
OBJECTIVES: This study investigated the incidence of appropriate implantable cardioverter defibrillator (ICD) interventions for ventricular tachycardia (VT) or ventricular fibrillation (VF) in patients with idiopathic dilated cardiomyopathy (IDC) and nonsustained VT in the presence of a left ventricular ejection fraction below 30%, versus in patients with syncope and patients with a history of VT or VF.
BACKGROUND: To date, only limited information is available about the prophylactic use of ICDs in patients with IDC.
METHODS: From January 1993 to July 2000, 101 patients with IDC underwent implantation of ICDs with electrogram storage capability at our institution. Patients were placed into one of three groups according to their clinical presentation: asymptomatic or mildly symptomatic nonsustained VT in the presence of a left ventricular ejection fraction  30% (49 patients, prophylactic group), unexplained syncope or near syncope (26 patients, syncope group) and a history of sustained VT or VF (26 patients, VT/VF group).
RESULTS: During 36 ± 22 months follow-up, 18 of 49 patients (37%) in the prophylactic group received appropriate shocks for VT or VF, compared with 8 of 26 patients (31%) in the syncope group and with 9 of 26 patients (35%) of the VT/VF group. Multivariate Cox analysis of baseline clinical variables identified left ventricular ejection fraction, atrial fibrillation and a history of sustained VT or VF as predictors for appropriate ICD interventions during follow-up.
CONCLUSION: Patients with IDC and prophylactic ICD implantation for nonsustained VT in the presence of a left ventricular ejection fraction 30% had an incidence of appropriate ICD interventions similar to that of patients with a history of syncope or sustained VT or VF. These findings indicate that ICDs may have a role in not only secondary but also primary prevention of sudden death in IDC.
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Abbreviations and Acronyms
| | ACE | | ACE | | angiotensin converting enzyme | | ICD | | implantable cardioverter defibrillator | | IDC | | idiopathic dilated cardiomyopathy | | LV | | left ventricle | | VF | | ventricular fibrillation | | VT | | ventricular tachycardia |
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