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From the Hospital of the Westfälische Wilhelms-University of
Münster, Departments of Cardiology (D. Böcker, D. Bänsch, M.W.,
J.B., M. Borggrefe, G.B., M. Block), Cardiothoracic Surgery (D.H.), Medical
Informatics (A.H.), and Institute for Arteriosclerosis Research (D.
Böcker, M. Borggrefe, G.B.) Münster, Germany.
Correspondence to Dirk Böcker, MD, Uniklinik Münster, Innere Medizin C, D-48129 Münster, Germany.
Background—Whether patients with
heart failure derive a benefit from therapy with implantable
cardioverter-defibrillators (ICDs) has been questioned. The purpose of
this study was to investigate whether New York Heart Association (NYHA)
functional class had an impact on the potential benefit from ICD
therapy as assessed from data stored in the memory of ICDs.
Methods and Results—Between 1989 and 1996, 603 patients (77%
men; 59% with coronary artery disease and 16% with dilated
cardiomyopathy; age, 57±13 years; ejection
fraction, 44±18%) were treated with an ICD with extended memory
function (storage of electrograms and/or RR intervals from treated
episodes) in combination with endocardial lead systems. The stages of
heart failure (NYHA functional class I through III) at implantation
were correlated with overall mortality and the recurrence of
fast ventricular tachyarrhythmias (>240
bpm) during follow-up. The potential benefit of the device was
estimated as the difference between overall mortality and the
hypothetical death rate had the device not been implanted. The latter
was based on the recurrence of fast and, without termination by
the devices, presumably fatal ventricular
tachyarrhythmias. In the overall group, a significant
difference between hypothetical death rate and overall mortality was
observed (13.9%, 23.5%, and 26.6% at 1, 3, and 5 years,
respectively) that suggested a benefit from ICD implantation. In
patients in NYHA class I, the estimated benefit, which increased over
time, was 15.2%, 29.2%, and 35.6% after 1, 3, and 5 years,
respectively. In patients in NYHA class II or III, the estimated
benefit increased until the third year (21.8% and 21.9%,
respectively) and then remained constant until the fifth year (22.9%
and 23.8%, respectively). Even those patients in NYHA class III with a
history of decompensated heart failure benefited from ICD
implantation.
Conclusions—Analysis of stored ECG data suggests that in
patients with a history of ventricular
tachycardia or ventricular fibrillation, ICD
therapy may lead to a prolongation of life in NYHA classes I through
III. The initial benefit is greatest in patients in NYHA class II and
class III, but the estimated benefit might persist longest for patients
in NYHA class I.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Potential Benefit From Implantable Cardioverter-Defibrillator Therapy in Patients With and Without Heart Failure
Key Words: heart failure • prognosis • cardioversion • defibrillation
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