Author + information
- Received October 12, 1993
- Revision received June 27, 1994
- Accepted June 30, 1994
- Published online December 1, 1994.
- Mark A Wood, MDa,∗,
- Bruce S Stambler, MD, FACCa,
- Ralph J Damiano, MDa,
- Patricia Greenway, RN∗,
- Kenneth A Ellenbogen, MD, FACCa,
- The Guardian ATP 4210 Multicenter Investigators Group†
- ↵∗Address for reprints: Dr. Mark A. Wood, Medical College of Virginia, MCV Box 53, Richmond, Virginia 23298.
Objectives. This study examined patterns of implantable cardioverter-defibrillator use as documented by data logging.
Background. Implantable cardioverter-defibrillators are accepted therapy for malignant ventricular tachyarrhythmias; however, relatively little is known about their patterns of use. Incorporation of data-storage capacities into these devices provides insight into long-term defibrillator function.
Methods. Stored data-logging information was retrieved from 401 implanted cardioverter-defibrillators in 393 patients over an average of 303 days of follow-up.
Results. A total of 91,443 detections were recorded in 299 patients. One hundred-six patients (26%) had detections due to supraventricular tachycardias, electrical noise or other causes, resulting in inappropriate therapy delivery to 92 patients (23%). Two hundred eighty-one patients recorded 66,276 episodes of ventricular tachycardia or ventricular fibrillation. Of these, 74.4% episodes terminated spontaneously without any delivered therapy, 22.1% terminated after antitachycardia pacing, and 1.7% terminated after shock therapy. Antitachycardia pacing was activated without formal testing in 47% of all patients receiving this therapy and was successful in 96% of all episodes receiving this therapy. Acceleration of tachycardia to shock therapy occurred in 1.3% of all episodes and in 30.5% of patients receiving antitachycardia pacing. Thirty-four patients (8.7%) died during follow-up. Mortality was associated with patient age, heart failure functional class at implantation and frequency of shocks received during follow-up (all p ≤ 0.05).
Conclusions. Most ventricular tachyarrhythmia detections by this noncommitted implantable cardioverter-defibrillator resolve spontaneously, whereas the majority receiving therapy can be treated with antitachycardia pacing. Mortality after implantable cardioverter-defibrillator implantation is associated with age, heart failure class and frequency of shocks received during follow-up. Data-logging capabilities provide valuable insights into the patterns of defibriliator use.
↵† A list of participating investigators and institutions appears in reference 9.
☆ This study wus supported by Telectronics Pacing Systems, Englewood. Colorado.
- Received October 12, 1993.
- Revision received June 27, 1994.
- Accepted June 30, 1994.