The role of implantable cardioverter defibrillator for primary vs secondary prevention of sudden death in patients with idiopathic dilated cardiomyopathy

Massimo Zecchin, Andrea Di Lenarda, Alessandro Proclemer, Giorgio Faganello, Domenico Facchin, Eugenio Petz, Gianfranco Sinagra
Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology 2004, 6 (5): 400-6

AIM: To analyse the characteristics and outcome of patients with idiopathic dilated cardiomyopathy (DC) considered at high risk of sudden death (SD) and treated with implantable cardioverter defibrillators (ICD) for primary prevention (Group A) in comparison with patients treated with ICDs because of previous sustained ventricular tachyarrhythmias or syncope (Group B).

METHODS: Group A consisted of 27 patients with at least two of the following criteria: left ventricular end-diastolic diameter (LVEDD) > or =70 mm (74%), LV ejection fraction (LVEF) < or =30% (78%), non-sustained ventricular tachycardia (VT) (56%), long history of disease (> or =48 months since diagnosis, 85%) and family history of SD (11%). Group B consisted of 27 patients treated with ICDs because of sustained VT/fibrillation (n=18) or syncope (n=9).

RESULTS: NYHA class, LVEF, LVEDD and amiodarone treatment were similar in the two groups. Patients in group A were younger (46+/-15 vs 59+/-17 years, P=0.0008), were more often treated with beta-blockers (89% vs 62%; P=0.02) and had a longer interval since diagnosis (86+/-60 vs 40+/-50 months; P=0.004). Twelve month rates of appropriate intervention (AI) were 41% in Group A and 57% in group B (P NS). In group A, after a mean follow-up of 21+/-14 months, patients showing the combination of LVEF < or =30% and LVEDD > or =70 mm had the highest frequency of AI (76% vs 10%, P=0.005). In group B, after a mean follow-up of 33+/-23 months, 78% of patients with syncope had AI. Total and sudden deaths were 11% and 4% in group A and 19% and 4% in group B (P NS).

CONCLUSIONS: Patients with idiopathic DC treated with ICD for primary prevention because they were considered at high risk of SD according to clinical criteria showed a high rate of AI, similar to that of patients treated for secondary prevention. The highest rate of AI was seen in patients with both severe dysfunction and dilatation and in those with previous syncope.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"