ICD-implantation guidelines versus clinical practice: a prospective study of out-of-hospital cardiac arrest survivors

AIMS: The aim of this study was prospectively to compare clinical practice of implantable cardioverter defibrillator (ICD) use with current guidelines in out-of-hospital cardiac arrest (OHCA) survivors. METHODS AND RESULTS: From January 2000 till March 2002, 70 consecutive patients (pts) discharged from 15 hospitals after OHCA, with ventricular fibrillation (VF) as initial rhythm were included. Documentation of diagnosis, left ventricular function, ischaemia, electrophysiological studies (EPS), and decisions regarding ICD implantation were obtained from medical records. An expert committee compared these data with current guidelines. According to these guidelines 18 pts (26%) had an ICD indication and received an ICD while 37 pts (53%) had no indication and did not receive an ICD. In 13 pts without acute myocardial infarction insufficient diagnostic procedures were performed to permit a decision on ICD indication, hence no ICD was implanted. Two pts had an ICD indication but did not receive an ICD. During the follow-up with duration of 25 months (range 12-38 months), two sudden deaths occurred in the group of pts without an ICD. Of the pts with an ICD, 4 pts (22%) were reported to have received one or more shocks for VT/VF. CONCLUSION: In at least 21% of OHCA survivors, insufficient diagnostic procedures concerning the indication for ICD implantation were performed or no ICD was implanted when indicated, despite clear guidelines. In particular, there was no proof of ischaemia prior to revascularization and no confirmation of the absence of ischaemia and EPS thereafter. Clinicians should be guided better in evaluating pts after OHCA concerning the indication for ICD implantation, especially when a transient of reversible condition was present or when treatment was sufficiently established safely to refrain from ICD implantation.