Left ventricular ejection fraction <25% was associated with earlier AICD discharge and shortened survival (p=0.008), while beta-blocker administration delayed discharge (p=0.006).
Cohort (n=218)
What are the predictors of first appropriate discharge and subsequent survival in patients with an automatic implantable cardioverter-defibrillator?
Severe left ventricular dysfunction predicts earlier appropriate AICD discharge and worse subsequent survival, whereas beta-blocker therapy and prior CABG are associated with later discharge.
BACKGROUND: Two hundred eighteen patients were evaluated in a two-phase approach (time to first appropriate discharge, survival after discharge) to identify factors that may be related to maximal benefit derived from use of an automatic implantable cardioverter-defibrillator (AICD). METHODS AND RESULTS: One hundred ninety-seven patients survived implantation of AICD, with or without concomitant cardiac surgery. One hundred five patients had an AICD discharge associated with syncope, presyncope, documented sustained ventricular tachycardia or fibrillation, or sleep at 9.1 +/- 11.1 months after implantation. Patients survived 23.8 +/- 18.0 months after AICD discharge. Left ventricular dysfunction (p = 0.008 for ejection fraction less than 25%) was associated with earlier AICD discharge and shortened survival after AICD discharge (p = 0.008 for ejection fraction less than 25%; p = 0.01 for New York Heart Association functional class III and IV). beta-Blocker administration (p = 0.006) and coronary bypass surgery (p = 0.06) were associated with later AICD discharge. Coronary bypass surgery (p = 0.035) but not beta-blockers was associated with more prolonged survival after AICD discharge. CONCLUSIONS: These data suggest that a relatively easy algorithm can be applied to predict which patient will benefit most from AICD implantation.
Levine et al. (Thu,) conducted a cohort in Patients with automatic implantable cardioverter-defibrillators (n=218). Predictors of AICD benefit (LVEF, beta-blockers, CABG) was evaluated on Time to first appropriate discharge and survival after discharge. Left ventricular ejection fraction <25% was associated with earlier AICD discharge and shortened survival (p=0.008), while beta-blocker administration delayed discharge (p=0.006).