Abstract
PurposeThe subcutaneous implantable defibrillator (S-ICD) was developed to avoid complications related to transvenous leads. A trade-off with the S-ICD is the inability to deliver antitachycardia pacing (ATP). Data is scarce about the recurrence and characteristics of ventricular tachyarrhythmias (VTa) during a follow-up in survivors of out-of-hospital cardiac arrest due to ventricular fibrillation (OHCA-VF). The aim of the study is to determine the characteristics of VTa triggering ICD therapy in order to assess whether survivors of OHCA-VF are eligible candidates for the S-ICD.MethodsAll OHCA-VF patients who received a transvenous ICD were identified, 378 patients, age 57 ± 14 years, predominantly male (76%) with ischemic heart disease (58%). Arrhythmic endpoints were appropriate ICD therapies for any ventricular arrhythmia.ResultsOver a median follow-up of 4.5 years, 690 VTa in 91 patients (24%) were terminated by ICD therapy; 70% of patients had < 5 VTa with ICD therapy. VTa with cycle length ≤ 300 ms were mainly (82%) treated by shock, while 83% of VTa with cycle length > 300 ms were treated by ATP. The presence of a remote myocardial infarction (OR 2.07; 95% CI 1.08–3.97) and LVEF ≤ 0.35 (OR 2.09; 95% CI 1.09–4.00) were significantly associated with the occurrence of VTa with cycle length > 300 ms.ConclusionS-ICD implantation may be reasonable in survivors of OHCA-VF who present without a remote myocardial infarction and LVEF > 35%.
Highlights
Placement of an implantable cardioverter-defibrillator (ICD) is a class 1A indication for survivors of cardiac arrest due to ventricular fibrillation (VF)
The aim of the study is to determine characteristics of ventricular arrhythmias triggering ICD therapy in order to assess whether survivors of of-hospital cardiac arrest due to ventricular fibrillation (OHCA-VF) are eligible candidates for the S-ICD
The mean cycle length of shocked ventricular tachyarrhythmias was 231 ± 41 ms, and the mean cycle length of ventricular tachyarrhythmias treated by antitachycardia pacing (ATP) was 307 ± 34 ms (P < 0.001)
Summary
Placement of an implantable cardioverter-defibrillator (ICD) is a class 1A indication for survivors of cardiac arrest due to ventricular fibrillation (VF). These recommendations are based on the results of randomized clinical trials [1,2,3,4]. ICD implantation in the setting of secondary prevention has been labeled as Bappropriate use^ in the recent Appropriate Use Criteria Task Force report [5]. Despite the effectiveness of the ICD in terminating life-threatening ventricular arrhythmias, contemporary transvenous ICD systems have been associated with. The aim of the study is to determine characteristics of ventricular arrhythmias triggering ICD therapy in order to assess whether survivors of OHCA-VF are eligible candidates for the S-ICD
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