Predictive Factors Of Appropriate Shock Therapy In Patients With Implantable Cardioverter Defibrillator





Implantable cardioverter defibrillators - Shock therapy -risk factors.


Appropriate shock therapy (AST) occurs in the minority of patients with implantable cardioverter defibrillators (ICDs). Evaluating predictors of ICD therapy may be helpful in developing risk stratification strategies for these patients. This could help the physician with his decision to offer ICD implantation. Expanding the indication to more permissive uses of ICD implantation seems to have resulted in selection of patients who are less likely to benefit from ICD. We assessed which patients received AST and whether there were any predictive factors.

Author Biographies






The antiarrhythmic versus implantable defibrillators (AVID) investigators. A comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med 1997;337:1576–83

-2. Moss AJ, Hall WJ, Cannom DS .Improved survival with an implanted defibrillator in patients with coronary artery disease at high risk for ventricular arrhythmia .N Engl J Med, 335 (1996), pp. 1933–1940.

-3. Buxton AE, Lee KL, Fisher JD .A randomised study of the prevention of sudden death in patients with coronary artery disease .N Engl J Med, 341 (1999), pp. 1882–1890.

-4. Grimm w, Flores BT and Marchlinski FE. Shock Occurrence and Survival in 241 Patients With Implantable Cardioverter- Defibrillator Therapy . Circulation.1993 ;87(6) :1880-88.

-5. Grunwald L ,Guarnieri L , Aarons D , Griffith LSC : Predictors of first discharge and subsequent survival in patients with automatic implantable cardioverter-defibrillators. Circulation 1991;84: 558-566.

-6. Kim SG, Fisher JD , Choue CW , Gross J ,Roth J , Ferric KJ , Brodman R, Furman S : Influence of left ventricular function on outcome of patients treated with implantable defibrillators. Circulation 1992;85:1304-1310.

-7. Jagmeet P , Hall WJ , McNitt S, Wang H, Daubert JP, Zareba W, Ruskin JN, Moss AJ, and the MADIT-II Investigators. Journal of the American College of Cardiology. 2005.46(9) : 1712-20.

-8. Rinaldi CA, Simon RDB , Baszko A, Bostock J, Elliot D, Bucknall C, Jaswinder SG . Can we predict which patients with implantable cardioverter defibrillators receive appropriate shock therapy? A study of 155 patients International Journal of Cardiology .88(1) :69-75.

-9. Denniss AR, Richards DA , Cody DV ..Prognostic significance of ventricular tachycardia and fibrillation induced at programmed stimulation and delayed potentials detected on the signal averaged electrocardiograms of survivors of acute myocardial infarction. Circulation, 74 (1986), pp. 731–745

-10. Roy D, Marchand E, Theroux P .Programmed ventricular stimulation in survivors of an acute myocardial infarction.Circulation, 72 (1985), pp. 487–494.

-11. Tebbenjohanns J, Schumacher, Jung W .Predictors of outcome in patients with transvenous cardioverter defibrillatorsAm Heart J, 127 (1994), pp. 1086–1089 .

-12. Andrews NP , Fogel RI , Pelargonio G. Implantable defibrillator event rates in patients with unexplained syncope and inducible sustained ventricular tachyarrhythmias: a comparison with patients known to have sustained ventricular tachycardia .JACC, 34 (1999), pp. 2023–2330.

-13. Otmani A, Trinquart L, Marijon E ,Lavergne T, Waintraub X, Lepillier A, Chatellier G, Le Heuzey JY .On Behalf of the EVADEF investigators .Rates and predictors of appropriate implantable cardioverter-defibrillator therapy delivery: Results from the EVADEF cohort study. American Heart Journal 158(2).2009:230-37.

-14. Huang SK, Messer JV, Denes P. Significance of ventricular tachycardia in idiopathic dilated cardiomyopathy: observations in 35 patients Am J Cardiol, 51 (1983), pp. 507–512.

-15. Levine JH, Mellits ED, Baumgardner RA, Veltri EP, Mower M, Grunwald L, Guarnieri T, Aarons D, Griffith LSC: Predictors of first discharge and subsequent survival in patients with automatic implantable cardioverter-defibrillators. Circulation 1991;84: 558-566

-16. Reiter MJ, Fain ES, Senelli KM, Cadence Investigators: Determinants of recurrent ventricular arrhythmias in patients with implantable pacemaker/defibrillators. Circulation 1991;84(suppl II):II-426;

-17. Gross J, Song SL, Buckingham T, Furman S, Bilitch Registry Group: Influence of clinical characteristics and shock occurrenceon ICD patient outcome: A multicenter report. PACE 1991;14: 1881-1886;

-18. Myerburg RJ, Luceri RM, Thurer R, Cooper DK, Zaman L,Interian A, Fernandez P, Cox M, Glicksman F, Castellanos A: Time to first shock and clinical outcome in patients receiving an automatic implantable cardioverter-defibrillator. JAm Coll Cardiol 1989;14:508-514 .

-19. Desai H, Aronow WS, Ahn C, Gandhi K, Hussain S, Hoang ML, Sharma M, Frishman WH, Cohen M, Sorbera C, .Risk Factors for Appropriate Cardioverter-Defibrillator Shocks, Inappropriate Cardioverter-Defibrillator Shocks, and Time to Mortality in 549 Patients With Heart Failure. The American Journal of Cardiology. 2010;105:1336–1338).

-20. Goldenberg I, Moss AJ, McNitt S, Zareba W, Daubert JP, Hall WJ, Andrews ML; Multicenter Automatic Defibrillator Implantation Trial-II Investigators. Cigarette smoking and the risk of supraventricularand ventricular tachyarrhythmias in high-risk cardiac patients with implantable cardioverter-defibrillators. J Cardiovasc Electrophysiol2006;17:931–936.

-21. Desai H, Aronow WS, Tsai F, Ahn C, Lai HM, Amin H, Gandhi K, Frishman WH, Cohen M, Sorbera C. Statins reduce appropriate cardioverter- defibrillator shocks and mortality in patients with heart failure and combined cardiac resynchronization and implantable cardioverter-defibrillator therapy. J Cardiovasc Pharmacol Ther 2009;14:176–179.

-22. Vyas AK, Guo H, Moss AJ, Olshansky B, McNitt SA, Hall WJ, ZarebaW, Steinberg JS, Fischer A, Ruskin J, Andrews ML, for the MADIT-II Research Group. Reduction in ventricular tachyarrhythmias with statins in the Multicenter Automatic Defibrillator Implantation trial (MADIT)-II. J Am Coll Cardiol 2006;47:769 –773.

-23. Mitchell LB, Powell JL, Gillis AM, Kehl V, Hallstrom AP; AVID Investigators. Are lipid-lowering drugs also antiarrhythmic drugs? An analysis of the antiarrhythmics versus implantable defibrillators (AVID) trial. J Am Coll Cardiol 2003;42:81– 87.

-24. De Sutter J, Tavernier R, De Buyzere M, Jordaens L, De Backer G. Lipid lowering drugs and recurrences of life-threatening ventricular arrhythmias in high-risk patients. J Am Coll Cardiol 2000;36:766–772.

-25. Lellouche N ,De Diego G ,Akopyan G, , Boyle GB, Mahajan , Cesario DA, Wiener I, Shivkumar K .Changes and predictive value of dispersion o.f repolarization parameters for appropriate therapy in patients with biventricular implantable cardioverter-defibrillators .Heart rythme. 4(10).2007:1274-83.

-26. Kanoupakis EM . Manios EG , Kallergis EM, Mavrakis HE, Goudis CA, Saloustros IG .Milathianaki ME,Chlouverakis GI, Vardas PE. Serum Markers of Collagen Turnover Predict Future Shocks in Implantable Cardioverter-Defibrillator Recipients With Dilated Cardiomyopathy on Optimal Treatment. Journal of the American College of Cardiology .55(24). 2010 :2753-9.

-27. Leah I , Pfluger H, Lefkovits L, Butler MJ, Kistler PM, Kaye DM, Taylor AJ. Myocardial Fibrosis Predicts Appropriate Device Therapy in Patients With Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death. Journal of the American College of Cardiology. 57(7) 2011 :821-8 .

-28. Whang W. Albert CM, Sears SM, Lampert R, Conti JB, Wang PG, Jagmeet PS. Ruskin JN, Muller JE, Mittleman MA, TOVA Study Investigators ;Depression as a Predictor for Appropriate Shocks Among Patients With Implantable Cardioverter-Defibrillators. Journal of the American College of Cardiology. (45) 7. 2005 :1090-5.

-29. Bhonsale A.,James CA, Tichnell C, Murray B, Gagarin D, Binu P, Darshan D, MD, Tedford R,

Russell SD, Abraham T, Tandri H, Judge DP, H Calkins. Incidence and Predictors of Implantable Cardioverter-Defibrillator Therapy in Patients With Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy Undergoing Implantable Cardioverter-Defibrillator Implantation for Primary Prevention. Journal of the American College of Cardiology. 58(14).2011 :1485-96.