Copyright © 1995 by the European Society of Cardiology.
© 1995 The European Society of Cardiology
Shock occurrence and survival in 49 patients with idiopathic dilated cardiomyopathy and an implantable cardioverter-defibrillator
Clinical Electrophysiology Laboratory, Cardiology Division, Department of Medicine, Hospital of the University of Pennsylvania Philadelphia, PA, U.S.A
*Philadelphia Heart Institute (Sidney Kimmel Cardiovascular Research Center) Philadelphia, PA, U.S.A
Received 20 September 1993; revised 14 June 1994; accepted 10 August 1994.
Correspondence: Wolfram Grimm, MD, Philipps-University Marburg. Zentrum für Innere Medizin — Abt Kardiologie, BaldingerstraBe, 35033 Marburg, Germany
Abstract
To determine shock occurrence and survival, 49 patients with idiopathic dilated cardiomyopathy presenting with cardiac arrest (82%), syncope (12%) or ventricular tachycardia without syncope (6%) were followed for 28 ±28 months after cardioverter-defibrillator (ICD) implant according to the intention to treat principle. Using the Kaplan-Meier method, the actuarial incidence for any spontaneous shocks was 20%, 58%, and 77%, and the incidence of appropriate shocks was 16%, 49%, and 72% at 1, 3, and 5 years of follow-up, respectively. Only two of 49 study patients (4%) with an active ICD died suddenly during follow-up. Another two patients, however, with an inactive device died suddenly, resulting in a sudden death rate of 2% per year with an active ICD, and 5% per year, according to the intention to treat principle. The incidence of cardiac death from any cause was 8%, 25%, and 35%, and the incidence of total mortality was 14%, 39%, and 49% during 1, 3, and 5 years of follow-up, respectively. There was no difference in the Kaplan-Meier survival curves for shocked vs non-shocked patients. Thus, in this selected patient population with idiopathic dilated cardiomyopathy the majority of patients received ‘appropriate’ shocks during follow-up, and the sudden death rate with active ICD is low.
Key Words: Idiopathic dilated cardiomyopathy • implantable cardioverter-defibrillator • sudden cardiac death • spontaneous shocks
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