CLINICAL STUDY: SUDDEN DEATH
Sudden death in patients with implantable cardioverter defibrillators
The importance of post-shock electromechanical dissociation
L. Brent Mitchell, MD, FACC*,*,
Edgar A. Pineda, MD ,
Jack L. Titus, MD ,
Paulette M. Bartosch and
David G. Benditt, MD, FACC||
* Foothills Hospital/University of Calgary, Calgary, Alberta, Canada
Cardiac Surgical Associates, Minneapolis, Minnesota, USA
Jesse E. Edwards Registry of Cardiovascular Disease of United Hospital, St. Paul, Minnesota, USA
Medtronic Inc., Minneapolis, Minnesota, USA
|| University of Minnesota, Minneapolis, Minnesota, USA
Manuscript received January 30, 2001;
revised manuscript received January 7, 2002,
accepted January 18, 2002.
* Reprint requests and correspondence: Dr. L. Brent Mitchell, Foothills Hospital, 1403-29th Street, Northwest Calgary, Alberta, Canada, T2N 2T9.
brent.mitchell{at}calgaryhealthregion.ca
OBJECTIVES: The purpose of this study was to determine the mechanisms of sudden death (SD) in patients with ventricular tachyarrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]) treated with an implantable cardioverter defibrillator (ICD).
BACKGROUND: Despite ICD therapy, some patients with VT/VF still die suddenly. Optimal ICD use requires determination of the mechanisms of these residual SDs.
METHODS: We reviewed 320 patient deaths during trials of Medtronic transvenous ICD systems (Medtronic Inc., Minneapolis, Minnesota). Sudden deaths were further categorized according to mechanism. Post-shock electromechanical dissociation (EMD) describes a scenario where VT/VF was appropriately detected and treated by an ICD shock that restored a physiologic rhythm, but death still occurred immediately by EMD.
RESULTS: A mode of death could be ascribed for 317 patients—90 (28%) were sudden, 156 (49%) were nonsudden cardiac, and 71 (22%) were noncardiac. A mechanism of SD was proposed for 68 patients—20 (29%) had post-shock EMD, 17 (25%) had VT/VF uncorrected by shocks, 11 (16%) had primary electromechanical dissociation, 9 (13%) had incessant VT/VF, 5 (7%) had VT/VF after their ICD was deactivated or removed, and 6 (9%) had single instances of various other terminal events. Only New York Heart Association functional class independently predicted SD by post-shock EMD.
CONCLUSIONS: The most common mechanism of SD in patients with an ICD is VT/VF treated with an appropriate shock followed by EMD. As this mechanism accounted for 29% of the SDs to which a cause could be ascribed, this mechanism of SD warrants further investigation.
|
Abbreviations and Acronyms
| | ED50 | | the median effective shock dose | | EMD | | electromechanical dissociation | | ICD | | implantable cardioverter defibrillator | | LD50 | | the medial lethal shock dose | | LVEF | | left ventricular ejection fraction | | NYHA | | New York Heart Association | | SD | | sudden death | | TD50 | | the median toxic shock dose | | VF | | ventricular fibrillation | | VT | | ventricular tachycardia |
|
This article has been cited by other articles:
|
|
|
|
 
G. Z. Duray, J. Schmitt, S. Richter, C. W. Israel, and S. H. Hohnloser
Arrhythmic death in implantable cardioverter defibrillator patients: a long-term study over a 10 year implantation period
Europace,
November 1, 2009;
11(11):
1462 - 1468.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Tung and C. D. Swerdlow
Refining Patient Selection for Primary Prevention Implantable Cardioverter-Defibrillator Therapy: Reeling in a Net Cast Too Widely
Circulation,
September 8, 2009;
120(10):
825 - 827.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. K. Shepard and K. A. Ellenbogen
Predicting outcome after implantable cardioverter-defibrillator therapy a new piece to the puzzle?
J. Am. Coll. Cardiol.,
August 25, 2009;
54(9):
829 - 831.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Blatt, J. E. Poole, G. W. Johnson, D. J. Callans, M. H. Raitt, R. K. Reddy, F. E. Marchlinski, R. Yee, T. Guarnieri, M. Talajic, et al.
No Benefit From Defibrillation Threshold Testing in the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial)
J. Am. Coll. Cardiol.,
August 12, 2008;
52(7):
551 - 556.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Carbucicchio, M. Santamaria, N. Trevisi, G. Maccabelli, F. Giraldi, G. Fassini, S. Riva, M. Moltrasio, M. Cireddu, F. Veglia, et al.
Catheter Ablation for the Treatment of Electrical Storm in Patients With Implantable Cardioverter-Defibrillators: Short- and Long-Term Outcomes in a Prospective Single-Center Study
Circulation,
January 29, 2008;
117(4):
462 - 469.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Almendral and M. E. Josephson
All Patients With Hemodynamically Tolerated Postinfarction Ventricular Tachycardia Do Not Require an Implantable Cardioverter-Defibrillator
Circulation,
September 4, 2007;
116(10):
1204 - 1212.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Brignole, G. Raciti, M. G. Bongiorni, G. De Martino, S. Favale, M. Gasparini, R. Luise, E. Occhetta, and A. Proclemer
Defibrillation testing at the time of implantation of cardioverter defibrillator in the clinical practice: a nation-wide survey
Europace,
July 1, 2007;
9(7):
540 - 543.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Kleemann, T. Becker, K. Doenges, M. Vater, J. Senges, S. Schneider, W. Saggau, U. Weisse, and K. Seidl
Annual Rate of Transvenous Defibrillation Lead Defects in Implantable Cardioverter-Defibrillators Over a Period of >10 Years
Circulation,
May 15, 2007;
115(19):
2474 - 2480.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. J. Bunch, S. H. Hohnloser, and B. J. Gersh
Mechanisms of Sudden Cardiac Death in Myocardial Infarction Survivors: Insights From the Randomized Trials of Implantable Cardioverter-Defibrillators
Circulation,
May 8, 2007;
115(18):
2451 - 2457.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. D. Day, R. N. Doshi, P. Belott, U. Birgersdotter-Green, M. Behboodikhah, P. Ott, K. A. Glatter, S. Tobias, H. Frumin, B. K. Lee, et al.
Inductionless or Limited Shock Testing Is Possible in Most Patients With Implantable Cardioverter- Defibrillators/Cardiac Resynchronization Therapy Defibrillators: Results of the Multicenter ASSURE Study (Arrhythmia Single Shock Defibrillation Threshold Testing Versus Upper Limit of Vulnerability: Risk Reduction Evaluation With Implantable Cardioverter-Defibrillator Implantations)
Circulation,
May 8, 2007;
115(18):
2382 - 2389.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Developed in Collaboration With the European Heart, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al.
ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death)
J. Am. Coll. Cardiol.,
September 5, 2006;
48(5):
e247 - e346.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Writing Committee Members, D. P. Zipes, A. J. Camm, M. Borggrefe, A. E. Buxton, B. Chaitman, M. Fromer, G. Gregoratos, G. Klein, A. J. Moss, et al.
ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society
Europace,
September 1, 2006;
8(9):
746 - 837.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Swerdlow
Reply
J. Am. Coll. Cardiol.,
February 1, 2005;
45(3):
468 - 468.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. D. Swerdlow
Reappraisal of implant testing of implantable cardioverter defibrillators
J. Am. Coll. Cardiol.,
July 7, 2004;
44(1):
92 - 94.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Greenberg, R. B. Case, A. J. Moss, M. W. Brown, E. R. Carroll, M. L. Andrews, and MADIT-II Investigators
Analysis of mortality events in the multicenter automatic defibrillator implantation trial (MADIT-II)
J. Am. Coll. Cardiol.,
April 21, 2004;
43(8):
1459 - 1465.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Della Bella and N. Trevisi
Catheter ablation: is it good for all postinfarction ventricular tachycardias?
Eur. Heart J.,
November 1, 2002;
23(21):
1645 - 1647.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Sudden Death in Patients with Implantable Cardioverter Defibrillators
Journal Watch Emergency Medicine,
July 17, 2002;
2002(717):
8 - 8.
[Full Text]
|
|
|
|
