Sudden death in implantable cardioverter-defibrillator recipients: clinical context, arrhythmic events and device responses
Luis A. Pires, MD, FACCa,
Michael H. Lehmann, MD, FACCa,
Russell T. Steinman, MD, FACCa,
John J. Baga, MD, FACCa,
Claudio D. Schuger, MD, FACCa and Participating Investigators*
a Arrhythmia Center/Sinai Hospital and Wayne State University School of Medicine, Detroit, Michigan, USA
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Figure 1 Pie chart illustrating the proportions of types of arrhythmic events associated with SD in ICD recipients who died out of the hospital.
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Figure 2 Final three stored tachyarrhythmic events (over a 38-min period) in patient no. 5, showing (A) sustained monomorphic VT terminated by a 550-V shock (*) after failed successive antitachycardia pacing therapies (ATP), occurring at 17:06 h with patient abruptly collapsing and, despite bystander cardiopulmonary resuscitation, found 6 min later by the emergency medical staff to be pulseless; (B) polymorphic VT successfully treated with a single shock after failed ATP, occurring at 17:43 h after unsuccessful advanced resuscitative efforts by the emergency medical staff and subsequently the emergency room staff; and (C) 1 min later, ongoing polymorphic VT, after ineffective ATP, inappropriately redetected as sinus rhythm (SRD). Note the progressive decrease and variability in the amplitude of the electrograms preceding SRD.
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