Can Alternative Pacing Therapy Solve the Problem of Heart Failure Death in ICD Patients?

  • A. Auricchio
  • H. Klein


The automatic implantable cardioverter-defibrillator (ICD) was originally conceived by Mirowski [1] as a device for detecting and terminating potentially lethal ventricular tachyarrhythmias. There is general agreement that the device has demonstrated its ability to significantly reduce the incidence of sudden cardiac death [2, 3], which has been definitively demonstrated by important prospective studies like MADIT and AVID [4]. This has resolved the question of whether the ICD is able to reduce overall mortality [5]. Nevertheless cardiac mortality remains 15% to 20% at 2 years in ICD patients [6,7].


Severe Congestive Heart Failure Biventricular Pace Conduction Disturbance Implantable Defibrillator Multicenter Automatic Defibrillator Implantation Trial 
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  1. 1.
    Mirowski M, Reid PR, Mower MM, Watkins L, Gott VL, Schauble JF, Langer A, Heilman MS, Kolenik S, Fischell RE, Weisfeld M (1980) Termination of malignant ventricular arrhythmias with an implanted automatic defibrillator in human beings. N Engl J Med 303: 322–324PubMedCrossRefGoogle Scholar
  2. 2.
    Fogoros RN, Fiedler SB, Elson JJ (1987) The automatic implantable cardioverter defibrillator in drug refractory ventricular tachyarrhythmias. Ann Intern Med 109: 529–534Google Scholar
  3. 3.
    Grimm W, Flores BT, Marchiulinski FE (1993) Shock occurrence and survival in 241 patients with implantable cardioverter-defibrillator therapy. Circulation 87: 1880–1888PubMedCrossRefGoogle Scholar
  4. 4.
    Moss A, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, Levine JH, Saksena S, Waldo AL, Wilber D, Brown MW, Heo M for the Multicenter Automatic Defibrillator Implantation Trial Investigators (1996) N Engl J Med 335: 1933–1940PubMedCrossRefGoogle Scholar
  5. 5.
    Fogoros RN (1991) The implantable defibrillator backlash. Am J Cardiol 67: 1424–1427PubMedCrossRefGoogle Scholar
  6. 6.
    Winkle RA, Mead RH, Ruder MA, Gaudiani VA, Smith NA, Buch WS, Schmidt P, Shipman T (1989) Long-term outcome with the automatic implantable cardioverter defibrillator. J Am Coll Cardiol 13: 1353–1361PubMedCrossRefGoogle Scholar
  7. 7.
    Myerburg RJ, Luceri RM, Thurer R, Cooper DK, Zaman L, Interian A, Fernandez A, Cox M, Glicksam F, Castellanos A (1989) Time to first shock and clinical outcome in patients receiving an automatic implantable cardioverter-defibrillator. J Am Coll Cardiol 14: 508–514PubMedCrossRefGoogle Scholar
  8. 8.
    Kim SG, Fisher JD, Furman S, Gross J, Zilo P, Roth JA, Ferrick KJ, Brodman R (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
  9. 9.
    Kim SG (1993) Implantable defibrillator therapy: does it really prolong life? How can we prove it?. Am J Cardiol 71: 1213–1218PubMedCrossRefGoogle Scholar
  10. 10.
    Sweeney MO, Ruskin JN, Garan H, McGovern BA, Guy ML, Torchiana DF, Vlahakes GJ, Newell JB, Semigra GJ, Dec GW (1995) Influence of implantable cardioverter/defibrillator on sudden death and total mortality in patients evaluated for cardiac transplantation. Circulation 92: 3273–3281PubMedCrossRefGoogle Scholar
  11. 11.
    Metha 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: 1608–1614CrossRefGoogle Scholar
  12. 12.
    Levine JH, Mellits ED, Baumgardner RA, Veltri EP, Mower M, Grunwald L, Guarnieri T, Aarons D, Griffith LSC (1991) Predictors of first discharge and subsequent survival in patients with automatic implantable cardioverter-defibrillators. Circulation 84: 558–566PubMedCrossRefGoogle Scholar
  13. 13.
    Hochleitner M, Hortnagl H, Fridrich L, Gschnitzer F (1992) Long-term efficacy of physiologic dual chamber pacing in the treatment of end-stage idiopathic dilated cardiomyopathy. Am J Cardiol 70: 1320–1325PubMedCrossRefGoogle Scholar
  14. 14.
    Auricchio A, Sommariva L, Salo RW, Scafuri A, Chiariello L (1993) Improvement of cardiac function with severe congestive heart failure and coronary artery disease with shortened AV delay. PACE 16: 2034–2043PubMedCrossRefGoogle Scholar
  15. 15.
    Gold MR, Feliciano Z, Gottlieb SS, Fisher ML (1995) Dual-chamber pacing with a short atrioventricular delay in congestive heart failure: A randomized study. J Am Coll Cardiol 26: 967–973PubMedCrossRefGoogle Scholar
  16. 16.
    Linde C, Gadler F, Edner M, Nordlander R, Rosenquist M (1994) Is DDD pacing with short AV delay a beneficial treatment in patients with severe heart failure? PACE 17: 744CrossRefGoogle Scholar
  17. 17.
    Pagani M, Fonani T, Montanari P, Seveso G, Romano S (1994) Effects of DDD pacing with atrioventricular delay in dilated cardiomyopathy. PACE 17: 822CrossRefGoogle Scholar
  18. 18.
    Neri R, Santini M, Gentilucci G, Romano S, Pagani M, Capucci A, Zardo F, Cazzin R, Puglisi A, Mangiameli S, Moracchini PV, De Ciuceis P, Circo A, Palermo P, Cavaglia S, De Seta F (1997) DDD pacing in patients with dilated cardiomyopathy and various degree of altered diastolic function. PACE 20: 1103CrossRefGoogle Scholar
  19. 19.
    Foster AH, Gold MR, McLaughlin JS (1995) Acute hemodynamic effects of atrioventricular pacing in humans. Ann Thorac Surg 59: 294–300PubMedCrossRefGoogle Scholar
  20. 20.
    Bakker PJ, Meijburg H, de Jonge N, van Mechelen R, Wittkampf, Mower M, Thomas A (1994) Beneficial effects of biventricular pacing in congestive heart failure PACE 17:820 (abstr)Google Scholar
  21. 21.
    Auricchio A, Salo RW (1997) Acute hemodynamic improvement by pacing in patients with severe congestive heart failure. PACE 20: 313–324PubMedCrossRefGoogle Scholar
  22. 22.
    Doval HC, Nul DR, Grancelli HO, Perrone SV, Bortman GR, Curiel R for Grupo de estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina (GESICA) (1994) Randomised trial of low-dose amiodarone in severe congestive heart failure. Lancet 344: 493–498Google Scholar
  23. 23.
    Singh SN, Fletcher RD, Fisher SG, Singh BN, Lewis HD, Deedwania PC, Massie BM, Colling C, Lazzeri D, for the Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure (1995) Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia. N Engl J Med 333: 77–82PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 1998

Authors and Affiliations

  • A. Auricchio
    • 1
  • H. Klein
    • 1
  1. 1.Abteilung KardiologieUniversitätsklinikumMagdeburgGermany

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