Is Total Mortality Really Reduced by the Implantable Cardioverter Defibrillator?
The fact that the implantable cardioverter defibrillator (ICD) has reduced arrhythmic sudden death to about 1% per year is no longer contested. Irrefutable dramatic evidence of this phenomenon comes from the stored electrograms, which have visually captured the interruptions of countless episodes of malignant sustained arrhythmias in thousands of patients. But these patients have sick hearts, and the question asked by some — and which we will address here — is whether this reduction in sudden death translates to an overall, meaningful benefit in overall survival.
KeywordsCardiac Arrest Ventricular Tachycardia Implantable Cardioverter Defibrillator Implantable Cardioverter Defibrillator Therapy Implantable Defibrillator
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
Kim, S, Fisher J, Furman S et al (1991) Benefits of implantable defibrillators are overestimated by sudden death rates and better represented by the total arrhythmic death rate. J Am Coll Cardiol 17: 1587–1592PubMedCrossRefGoogle Scholar
Kim S (1993) Implantable defibrillator therapy: does it really prolong life? How can we prove it? Am J Cardiol 71: 1213–1218PubMedCrossRefGoogle Scholar
Levine J, Mellits E, Baumgardner R, Veltri E et al (1991) Predictors of first discharge and subsequent survival in patients with automatic implantable cardioverter defibrillators. Circulation 84: 558–566PubMedGoogle Scholar
Fogoros R, Fiedler S, Elson J (1987) The automatic implantable cardioverter defibrillator in drug-refractory ventricular arrhythmias. Ann Intern Med 107: 635–641PubMedGoogle Scholar
Newman D, Sauve J, Herre J et al (1992) Survival after implantation of the cardioverter defibrillator. Am J Cardiol 69: 889–903CrossRefGoogle Scholar
Böcker D, Block M, Isbruch F, Wietholt D et al (1993) Do patients with an implantable defibrillator live longer? J Am Coll Cardiol 21: 1638–1644PubMedCrossRefGoogle Scholar
Schlepper M, Neuzner J, Pitschner H (1995) Implantable cardioverter defibrillator: effect on survival. PACE 18: 569–578PubMedCrossRefGoogle Scholar
Greene H, CASCADE Investigators (1991) Cardiac arrest in Seattle: conventional versus amiodarone drug evaluation: the Cascade Study. Am J Cardiol 67: 578–584CrossRefGoogle Scholar
CASCADE Investigators (1993) Randomized antiarrhythmic drug therapy in survivors of cardiac arrest (the CASCADE Study). Am J Cardiol 72: 280–287CrossRefGoogle Scholar
Powell A, Finkelstein D, Garan H et al (1993) Influence of implantable cardioverter-defibrillators on the long-term prognosis of survivors of out-of-hospital cardiac arrest. Circulation 88: 1083–1092PubMedGoogle Scholar
Myerburg R, Luceri R, Thurer R et al (1989) Time to first shock and clinical outcome in patients receiving an automatic implantable cardioverter defibrillator. J Am Coll Cardiol 14: 508–514PubMedCrossRefGoogle Scholar
Mehta D, Saksena S, Krol R (1992) Survival of implantable cardioverter-defibrillator recipients: role of left ventricular function and its relationship to device use. Am Heart J 124: 1608–1614PubMedCrossRefGoogle Scholar
Weyer E, Hauer R, Van Capelle F et al (1995) Randomized study of implantable defibrillator as first-choice therapy versus conventional strategy in postinfarct sudden death survivors. Circulation 91: 2195–2203Google Scholar
Gartman D, Bardy G, Allen M et al (1990) Short-term morbidity and mortality of implantation of automatic implantable cardioverter-defibrillator. J Thorac Cardiovasc Surg. 100: 353–359PubMedGoogle Scholar
Connolly S, Yusuf S (1992) Evaluation of the implantable cardioverter defibrillator in survivors of cardiac arrest: the need for randomized trials. Am J Cardiol 69: 959–962PubMedCrossRefGoogle Scholar
Fogoros R (1994) An AVID Dissent (Editorial). PACE 17: 1707–1710PubMedCrossRefGoogle Scholar
Sweeney M, Ruskin J (1994) Mortality benefits and the implantable cardioverter defibrillator. Circulation 89: 1851–1858PubMedGoogle Scholar
Greene H (1994) Antiarrhythmic drugs versus implantable defibrillators: the need for a randomized controlled study. Am Heart J 127: 1171–1178PubMedCrossRefGoogle Scholar
© Springer-Verlag Italia, Milano 1996