DOES THE INITIAL PRESENTATION OF PATIENTS WITH IMPLANTABLE DEFIBRILLATOR INFLUENCE THE OUTCOME

The influence of the clinical presentation on the long-term outcome in 213 consecutive patients with ICDs, ECG storage capability, and nonth oracotomy leads, was analyzed. Sixty-six patients presented with cardi ac arrest (CA), 81 patients with hemodynamically stable VT, and 66 pat ients with syncope (SY). Patient characteristics were: mean age CA 62, VT 61, SY 61 years; mean ejection fraction CA 31%, VT 29%, SY 30%; co ronary artery disease CA 71%, VT 71%, SY 64% (all P >0.05 Fisher's exa ct test); female gender CA 40%, VT 14%, SY 29% (CA vs VT and SY, P <0. 005); inducibility by programmed stimulation CA 50%, VT 84%, SY 61% (V T vs CA and SY, P <0.001, CA vs SY, P >0.05). During a mean followup o f 14.5 months, 29 patients died: CA 12%, VT 14%, SY 9% (P >0.05). Comp aring Kaplan-Meier curves, no difference in the time course of overall mortality was found (log-rank P >0.05). In the CA, VT, and SY groups, 543, 1,630, and 189 ICD therapies (including antitachycardia pacing, low energy cardioversion, and defibrillation) were observed, respectiv ely. Actuarial analysis showed a shorter interval between implantation and first ICD therapy for VT versus CA and SY (log-rank P <0.005). Pa tients presenting with VT experienced earlier and more frequent ICD th erapies than patients with CA or SY independent of age, ejection fract ion, and heart disease. No difference in overall mortality and time co urse of fatal events was observed among the three groups.