Why the study?
Does an implantable cardioverter defibrillator (ICD) improve survival in patients with poor left ventricular function (LVEF < 30%)?
Does an implantable cardioverter defibrillator (ICD) improve survival in patients with poor left ventricular function (LVEF < 30%)?
ICD therapy significantly improves 5-year survival in patients with severe left ventricular dysfunction (LVEF < 30%), suggesting prevention of premature arrhythmic death.
Supports ICD benefit in severe LV dysfunction; hypothesis-generating and should not yet change practice without randomized confirmation.
Mortality in patients with cardiovascular disease is generally due to pump failure or lethal ventricular arrhythmias. In patients with ventricular tachycardia (VT) or ventricular fibrillation (VF) and poor left ventricular (LV) function the death rate is particularly high. The overall incidence of premature arrhythmic death rate in patients with poor LV function is not totally clear. Since implantable cardioverter defibrillator (ICD) could prevent arrhythmic death in any population, we proceeded to analyze mortalities in patients with poor LV function who received ICD. Among a total of 200 consecutive patients receiving ICD at our institution, 68 (34%) had LV ejection fraction (LVEF) of less than 30%. Thirty-one of these (45%) experienced appropriate ICD discharges and 17/31 (55%) had multiple shocks. Survival curves in this population revealed a 5 year projected overall survival of 11% whereas an actual survival was 60%. Even those who ultimately died from nonsudden causes, life was prolonged by ICD in a significant number of cases. Based upon these findings it is concluded that ICD has a major impact on survival in patients with poor LV function suggesting that many of these patients die prematurely from arrhythmia causes.
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Axtell et al. (1991) studied this question.
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