Abstract 19007: Defibrillator Therapy in Coronary Artery Disease and Idiopathic Dilated Cardiomyopathy. Is There Really a Difference? A Real Life Single Center Experience in 778 Patients.
Methods: 778 consecutive patients with either IHD (n=555) or IDC (n=223) were implanted with an Implantable Cardioverter Defibrillator (ICD) and followed for a mean period of 34 months.
Results: The proportion of males was significantly higher in both groups (IHD 85% vs. IDC 75%, p<0.05). Patients with coronary artery disease were significantly older (70 +/− 10 years vs. 66 +/− 12 years, p<0.05). The mean ejection fraction was 33 +/−11% in IHD and 28 +/− 10% in IDC patients (p<0.05). Indication for ICD implantation was primary prophylaxis in 445 (80%) patients with IHD and 201 (90%) patients with IDC. The mean time to the first spontaneous ventricular tachyarrhythmia (ventricular tachycardia or ventricular fibrillation, VT/VF) was 17 months in patients with IHD and 21 months in patients IDC (ns). Spontaneous VT/VF episodes occurred in 28% of patients with IHD and 30% of patients with IDC (p=ns), with a mean number of 21 vs. 22 episodes per patient, respectively. The episodes consisted in VT in 24% of IHD patients and 26% of IDC patients and VF in 12% vs. 13.5%, respectively (p=ns). 87 % off all ventricular tachyarrhythmias were successfully terminated by antitachycardia pacing (ATP) with an empiric programming of VT/VF cut off rates of 360 ms and 280 ms, respectively.
Conclusions: 1) In contrast to prior data, there were no significant differences in the characteristics of VT/VF events between patients with IHD and IDC 2) A probable explanation could be the increasing rate of primary prophylactic ICD implantation in this population with severely reduced ejection fraction. 3) The high incidence of spontaneous VT/VF events in IDC supports the primary prophylactic ICD-Implantation in this patient group.
- © 2010 by American Heart Association, Inc.