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(Circulation. 2003;108:1954.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Impact of Viability, Ischemia, Scar Tissue, and Revascularization on Outcome After Aborted Sudden Death

Alida E. Borger van der Burg, MD; Jeroen J. Bax, MD; Eric Boersma, PhD; Ernest K.J. Pauwels, MD; Ernst E. van der Wall, MD; Martin J. Schalij, MD

From the Department of Cardiology, Leiden University Medical Center, Leiden, and Department of Epidemiology/Statistics (E.B.), Erasmus University Rotterdam, the Netherlands.

Correspondence to Jeroen J. Bax, MD, PhD, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, the Netherlands. E-mail jbax{at}knoware.nl

Received February 24, 2003; de novo received May 21, 2003; revision received July 22, 2003; accepted July 22, 2003.

Background— Survivors of aborted sudden death attributable to ventricular arrhythmias in the presence of coronary artery disease are at risk for recurrences. The substrate underlying these arrhythmias is not clear, and therefore the relation between ischemia, viability, scar tissue (and revascularization), and the incidence of ventricular arrhythmias (and survival) was studied over up to 3 years.

Methods and Results— One hundred fifty-three survivors of sudden death underwent stress-rest perfusion imaging. Patients with ischemic/viable myocardium (n=73) were revascularized if possible. Final antiarrhythmic therapy was based on the outcome of electrophysiological testing or left ventricular ejection fraction (LVEF). Implantation of a defibrillator was performed in 112 (72%) patients. During 3-year follow-up, 15 cardiac deaths occurred and 42 (29%) patients had recurrent ventricular arrhythmias. Patients with events (death or recurrence) exhibited more often a severely depressed LVEF (30%), more extensive scar tissue, and less ischemic/viable myocardium on perfusion imaging and less frequently underwent revascularization. Multivariate analysis identified extensive scar tissue and LVEF 30% as the only predictors of death/recurrent ventricular arrhythmias.

Conclusions— In patients with aborted sudden death, extensive scar tissue and severely depressed LVEF are the only predictors of death or recurrent ventricular arrhythmias. These patients should be considered for implantation of a defibrillator.

Key Words: ischemia • arrhythmia • death, sudden

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