Vnitr Lek 2005, 51(11):1266-1271

Risk markers influencing mortality of patients with implantable cardioverter-defibrillators

M. Kozák^*, L. Křivan, M. Sepši, J. Vlašínová

Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC

Objective:
The effectivity of ICD therapy is usually evaluated according to the total mortality of ICD patients. The aim of this study is to analyse the total mortality of long-term followed ICD patients and describe potential markers increasing mortality.

Patients and methods:
We have observed 138 consecutive patients in mean age of 62.0 ± 12.2 year (108 M, 30 F) with mean LV EF 0.38 ± 0.14, who had ICD implanted for malignant ventricular arrhythmias from X/95 to XII/02. The mean follow-up was 47.35 months. 99 patients had CAD (coronary artery disease), 16 CMP (dilated cardiomyopathy), 5 ARVC (right ventricle dysplazia) , 4 LQT syndrom, 1 valvular disease and 13 pts were without structural heart disease.

Results:
The total mortality of the group of patients was 22 % (31 patients). The terminal heart failure was the main cause of death in our patients - in 84 % of the cases. We had no sudden death in our group of patients. There were no statistically significant differences observed between males and females. The statistically significant higher mortality was in patients above 66 years old, with severe left ventricle dysfunction - LV EF < 0.35 (18 % versus 8 %), in patients where the revascularization was not possible before ICD implantation (38 % versus 20 %) and then in patients with an arrhythmic storm after ICD implantation (37 % versus 17 %). The highest mortality (27 %) was in patients with CAD, nobody died in the group of patients without structural heart disease. One-year survival of the whole group of pts covered 90 % and two-year survival was 87 %.

Conclusions:
The survival of ICD patients is limited minimaly due to four factors: prior ICD implantation there is impossibility to revascularize patients with CAD, low LV EF < 0.35, age above 66 years and after ICD implantation the highest mortality occured to patients with arrhythmic storm during follow-up.

Keywords: ICD survival; mortality; risk markers

Received: February 3, 2005; Accepted: April 27, 2005; Published: November 1, 2005  Show citation