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Europace Advance Access originally published online on September 29, 2009
Europace 2009 11(11):1462-1468; doi:10.1093/europace/eup246
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

ICD

Arrhythmic death in implantable cardioverter defibrillator patients: a long-term study over a 10 year implantation period

Gabor Z. Duray, Joern Schmitt, Sergio Richter, Carsten W. Israel and Stefan H. Hohnloser*

Division of Cardiology, Section Clinical Electrophysiology, Department of Medicine, J.W. Goethe University, Theodor-Stern-Kai 7, Frankfurt 60590, Germany

Aims: Evaluation of cause-specific mortality in a large cohort of unselected implantable cardioverter defibrillator (ICD) recipients.

Methods and results: Causes of death of consecutive ICD recipients implanted over a 10 year period were analysed. Overall 822 patients (age 63 ± 11 years, 80% male, EF 34 ± 14%, secondary prevention 65%) were followed for 43 ± 30 months during which time 225 patients died (annual mortality 7.6%). Causes of death were cardiac arrhythmic in 16%, cardiac non-arrhythmic in 39%, non-cardiac vascular in 4%, non-cardiovascular in 27%, and unknown in 13%. Advanced age [relative risk (RR) 1.23 per decades, 95% confidence interval (CI) 1.06–1.43], NYHA class >II (RR 2.27, 95% CI 1.51–3.41), renal failure (RR 1.57, 95% CI 1.15–2.14), use of amiodarone (RR 2.56, 95% CI 1.91–3.43), digitalis (RR 1.87, 95% CI 1.40–2.49), diuretics (RR 1.89, 95% CI 1.35–2.66) were independent predictors of all-cause mortality. Predictors for arrhythmic mortality were NYHA class >II (RR 12, 95% CI 3.69–37.5), spontaneous or inducible VT as indication for ICD therapy (RR 2.53, 95% CI 1.06–6.05), and use of amiodarone (RR 3.95, 95% CI 2.02–7.75).

Conclusion: In this unselected group of ICD recipients, at least 16% of patients died from arrhythmic causes. Risk factors associated with arrhythmic mortality were a history of spontaneous or inducible VT, higher NYHA class, and amiodarone use.

Key Words: Implantable defibrillator, Sudden cardiac death, Arrhythmogenic death, Mortality in ICD recipients

* Corresponding author. Tel: +49 69 6301 7404; fax: +49 61 7395 0290. E-mail address: hohnloser{at}em.uni-frankfurt.de

Manuscript submitted 11 May 2009. Accepted after revision 6 August 2009.


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