Implantable cardioverter defibrillator utilization among device recipients presenting exclusively with syncope or near-syncope.
| Title: | Implantable cardioverter defibrillator utilization among device recipients presenting exclusively with syncope or near-syncope. |
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| Authors: | Militianu A; The Arrhythmia Center/Sinai Hospital and St. John Hospital, Detroit, Michigan 48235, USA.; Salacata A; Seibert K; Kehoe R; Baga JJ; Meissner MD; Pires LA; Schuger CD; Steinman RT; Mosteller RD; Palti AJ; David JB; Lessmeier TJ; Lehmann MH |
| Source: | Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 1997 Oct; Vol. 8 (10), pp. 1087-97. |
| Publication Type: | Clinical Trial; Journal Article; Multicenter Study |
| Language: | English |
| Journal Info: | Publisher: Blackwell Country of Publication: United States NLM ID: 9010756 Publication Model: Print Cited Medium: Print ISSN: 1045-3873 (Print) Linking ISSN: 10453873 NLM ISO Abbreviation: J Cardiovasc Electrophysiol Subsets: MEDLINE |
| Imprint Name(s): | Publication: Malden, MA : Blackwell; Original Publication: Mt. Kisco, N.Y. : Futura Pub., c1990- |
| MeSH Terms: | Defibrillators, Implantable*; Electric Countershock/*instrumentation ; Syncope/*therapy; Adult ; Aged ; Aged, 80 and over ; Data Collection ; Electric Stimulation Therapy ; Electrocardiography ; Female ; Follow-Up Studies ; Heart Function Tests ; Humans ; Male ; Middle Aged ; Survival Analysis |
| Abstract: | Introduction: Implantable cardioverter defibrillators (ICDs) are occasionally used in presumed high-risk patients with electrocardiographically undocumented syncope, although the incidence of ventricular tachyarrhythmias in this population is not well defined.; Methods and Results: We studied 33 consecutive patients receiving an ICD (67% nonthoracotomy and 70% tiered therapy) after electrophysiologic testing for unmonitored "syncope" (n = 29) or "near-syncope" (n = 4). Atherosclerotic heart disease was present in 24 (73%); mean left ventricular ejection fraction (LVEF) was 0.39 +/- 0.15; and sustained monomorphic ventricular tachycardia (SMVT) was inducible in 18 (55%). Over a median follow-up of 17 months (range 4 to 61), 12 patients (36%) received > or = 1 appropriate ICD discharge triggered by SMVT (cycle length 230 to 375 msec) in 10 and ventricular flutter or fibrillation in 2--without concomitant antiarrhythmic medication in 8 of 12 cases. Inducible SMVT and LVEF < or=0.35 were statistically significant, independent predictors of an appropriate ICD discharge (P < 0.02 and P < 0.03, respectively). Estimated 1-year cumulative survival free of appropriate discharge was 34% versus 87%, respectively, in patients with versus without inducible SMVT (P < 0.02), and 18% versus 56%, respectively, in patients with LVEF < or=0.35 versus LVEF > 0.35 (P < 0.03).; Conclusion: In this highly select, multicenter population of ICD recipients with electrocardiographically undocumented syncope, a substantial incidence of appropriate device discharges was observed, particularly in patients with inducible SMVT and LVEF < or = 0.35. These findings support the notion that, in patients with LV dysfunction and inducible SMVT, ventricular tachyarrhythmias are likely to account for episodes of syncope or near-syncope. |
| Comments: | Comment in: J Cardiovasc Electrophysiol. 1997 Oct;8(10):1098-101. doi: 10.1111/j.1540-8167.1997.tb00995.x.. (PMID: 9363812) |
| Entry Date(s): | Date Created: 19971118 Date Completed: 19971204 Latest Revision: 20190909 |
| Update Code: | 20260130 |
| DOI: | 10.1111/j.1540-8167.1997.tb00994.x |
| PMID: | 9363811 |
| Database: | MEDLINE |
Clinical Trial; Journal Article; Multicenter Study