Key Points
- To determine how myocardial ischemia, viability, scar tissue, and revascularization correlate with recurrent ventricular arrhythmias and survival in survivors of aborted sudden cardiac death.
- Evaluated 153 survivors of sudden death using stress-rest perfusion imaging, offering revascularization to patients with ischemic or viable myocardium (n=73).
- Tailored antiarrhythmic therapy based on electrophysiological testing or left ventricular ejection fraction (LVEF), implanting a cardioverter-defibrillator in 112 (72%) patients.
- Followed patients for up to 3 years to assess cardiac death and arrhythmia recurrences.
- During 3-year follow-up, 15 cardiac deaths occurred and 42 (29%) patients experienced recurrent ventricular arrhythmias.
- Patients with death or recurrence significantly more often had a severely depressed LVEF (≤30%), more extensive scar tissue, less ischemic/viable myocardium, and lower revascularization rates.
- Multivariate analysis identified extensive scar tissue and an LVEF ≤30% as the only independent predictors of cardiac death or recurrent ventricular arrhythmias.
Structured PICO
PPopulation153 survivors of aborted sudden death attributable to ventricular arrhythmias in the presence of coronary artery disease
OOutcomeComposite of cardiac death or recurrent ventricular arrhythmias over up to 3 years follow-upcomposite
In survivors of aborted sudden death, extensive scar tissue and severely depressed LVEF (<=30%) are the primary predictors of recurrent ventricular arrhythmias or cardiac death, supporting the use of ICDs in this high-risk population.