Abstract 2689: Death Causes in a Cohort of 2418Patients with an Implanted Defibrillator: The EVADEF Registry
The EVADEF registry is a medico-economic survey conducted with a state grant under the auspices of the French ministry of health. It included 2418 patients (mean age 60 ± 15 years, males 86 %) implanted with a cardioverter defibrillator (ICD) in 22 centers between June 2001 and June 2003. They have been followed up to June 2005. Their underlying heart diseases were ischemic (59.7%), dilated cardiomyopathy (15.9 %), hypertrophic obstructive cardiomy-opathy (5.6 %), Brugada syndrome (5.2 %), valvular cardiopathy (4.1 %), arrhythmogenic right ventricular dysplasia (3.3 %) and long QT syndrome (0.9 %). In 7.1 % of the cases the patients were implanted for an idiopathic ventricular fibrillation. Their mean ejection fraction was 38.9 ± 15.9 %, they were in NYHA class I in 33.3 % of the cases, II in 50.5 %, III in 14.7 % and IV in 1.5 %. The implanted devices were VVI in 48.3 %, DDD in 42.9 %, cardiac resynchronization therapy (CRT) plus defibrillator in 8.3 % and dual defibrillator in 0.5 %. A complication occurred in 328 patients (13.6 %) during the perioperative period. The main complications were haematoma (39.5 % if the complications), early reintervention (5.6 %) and pneumothorax (5.1 %). The mortality of this perioperative period was 2.4 %. The mortality rate was 5.3 % at 1 year and 8.7 % at 2 years. A proportion of 37.5 % of the deaths was due to heart failure, 13 % to cardiac arrest with electromechanical dissociation, 6.9 % to septic shock and 4.6 % to complications occurring after heart transplantation. An arrhythmic storm was the cause of the death in 6 % of the cases. A non cardiovascular death was observed in 11 % of the cases, including cancers in 6 %. In conclusion, heart failure and hemodynamic cardiac arrests remain the first causes of death in ICD patients, whatever the reason for implantation, followed by non cardiovascular deaths. Arrhythmic causes of deaths represent only 6 % of the mortality. Implantation of defibrillators plus CRT could probably in the future decrease these mortality rates, mainly by limiting the number of deaths due to heart failure.