Implantable Cardioverter Defibrillators Have Reduced the Incidence of Resuscitation for Out of Hospital Cardiac Arrest Caused by Lethal Arrhythmias
Background—Over the last decades, a gradual decrease in ventricular fibrillation (VF) as initial recorded rhythm during resuscitation for out of hospital cardiac arrest (OHCA) has been noted. We aimed to establish the contribution of Implantable Cardioverter Defibrillator (ICD) therapy to this decline.
Methods and Results—Using a prospective database of all OHCA resuscitation in the province North-Holland in The Netherlands (ARREST), we collected data on all patients in whom resuscitation for OHCA was attempted in 2005-2008. VF OHCA incidence (per 100.000 inhabitants/year) was compared with VF OHCA incidence data from 1995-1997, collected in a similar way. We also collected ICD interrogations of all ICD patients from North-Holland and identified all appropriate ICD shocks in 2005-2008; we calculated the number of prevented VF OHCA episodes considering that only part of the appropriate shocks would result in avoided resuscitation. VF OHCA incidence decreased from 21.1/100,000 in 1995-1997 to 17.4/100,000 in 2005-2008 (p<0.001). Non-VF OHCA increased from 12.2/100,000 to 19.4/100,000 (p<0.001). VF as presenting rhythm declined from 63% to 47%. In 2005-2008, 1972 ICD patients received 977 shocks. Of these shocks, 339 were caused by a life-threatening arrhythmia. We estimate that these 339 shocks have prevented 81 (min 39, max 152) cases of VF OHCA, corresponding with 33% (min 16%, max 63%) of the observed decline in VF OHCA incidence.
Conclusions—The incidence of VF-OHCA decreased over the last 10 years in North-Holland. ICD therapy explained a decrease of 1.2/100,000 inhabitants/year, corresponding with 33% of the observed decline in VF OHCA.
- cardiopulmonary resuscitation
- heart arrest
- implantable cardioverter-defibrillator
- ventricular fibrillation
- Received December 22, 2011.
- Accepted June 8, 2012.
- Copyright © 2012, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited