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Sudden death in patients with implantable cardioverter defibrillators: the importance of post-shock electromechanical dissociation.

Abstract：

OBJECTIVES:The purpose of this study was to determine the mechanisms of sudden death (SD) in patients with ventricular tachyarrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]) treated with an implantable cardioverter defibrillator (ICD). BACKGROUND:Despite ICD therapy, some patients with VT/VF still die suddenly. Optimal ICD use requires determination of the mechanisms of these residual SDs. METHODS:We reviewed 320 patient deaths during trials of Medtronic transvenous ICD systems (Medtronic Inc., Minneapolis, Minnesota). Sudden deaths were further categorized according to mechanism. Post-shock electromechanical dissociation (EMD) describes a scenario where VT/VF was appropriately detected and treated by an ICD shock that restored a physiologic rhythm, but death still occurred immediately by EMD. RESULTS:A mode of death could be ascribed for 317 patients-90 (28%) were sudden, 156 (49%) were non-sudden cardiac, and 71 (22%) were noncardiac. A mechanism of SD was proposed for 68 patients-20 (29%) had post-shock EMD, 17 (25%) had VT/VF uncorrected by shocks, 11 (16%) had primary electromechanical dissociation, 9 (13%) had incessant VT/VF, 5 (7%) had VT/VF after their ICD was deactivated or removed, and 6 (9%) had single instances of various other terminal events. Only New York Heart Association functional class independently predicted SD by post-shock EMD. CONCLUSIONS:The most common mechanism of SD in patients with an ICD is VT/VF treated with an appropriate shock followed by EMD. As this mechanism accounted for 29% of the SDs to which a cause could be ascribed, this mechanism of SD warrants further investigation.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Mitchell LB,Pineda EA,Titus JL,Bartosch PM,Benditt DG

doi

10.1016/s0735-1097(02)01784-9

subject

Has Abstract

pub_date

2002-04-17 00:00:00

pages

1323-8

issue

8

eissn

0735-1097

issn

1558-3597

pii

S0735109702017849

journal_volume

39

pub_type

杂志文章

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