DO PATIENTS WITH AN IMPLANTABLE DEFIBRILLATOR LIVE LONGER

Objectives. This study was done to provide information on the potentia l benefit of implantable cardioverter-defibrillator therapy regarding sudden and arrhythmia-related deaths and to examine whether such thera py improves survival. Background. Implantation of automatic cardiovert er-defibrillators is reported to abort sudden cardiac death due to mal ignant tachyarrhythmias. Methods. Between 1989 and 1992, 107 patients were screened for implantation of a third-generation implantable cardi overter-defibrillator combined with endocardial leads. Mean age was 57 +/- 13 years and mean ejection fraction was 40 +/- 15 %. Sudden death , total arrhythmia-related death and total cardiac death were compared with the occurrence of fast ventricular tachyarrhythmias (> 240 beats /min), assuming that most of these arrhythmias would have been fatal w ithout treatment by the implantable cardioverter-defibrillator. Result s. The surgical mortality rate was 2.7% in all 107 patients and 1% in the 99 patients who qualified for endocardial leads. During a follow-u p period of 12 +/- 8 months, actuarial survival rate free of events at 6 months as well as at 12 and 18 months was 100% for sudden death, 97 % for total arrhythmia-related death and 95% for total cardiac death. In contrast, after 6, 12 and 18 months, the rate of survival free of f ast ventricular tachycardia was only 83%, 74% and 69%, respectively, a nd the rate of survival free of any ventricular tachyarrhythmia was on ly 59%, 49% and 40%, respectively. Conclusions. The outcome of patient s treated with an implantable cardioverter-defibrillator and endocardi al defibrillation leads is excellent. For many patients, this treatmen t is probably lifesaving.