PMID- 9778329
OWN - NLM
STAT- MEDLINE
DCOM- 19981105
LR  - 20190623
IS  - 0009-7322 (Print)
IS  - 0009-7322 (Linking)
VI  - 98
IP  - 16
DP  - 1998 Oct 20
TI  - Potential benefit from implantable cardioverter-defibrillator therapy in patients 
      with and without heart failure.
PG  - 1636-43
AB  - BACKGROUND: Whether patients with heart failure derive a benefit from therapy 
      with implantable cardioverter-defibrillators (ICDs) has been questioned. The 
      purpose of this study was to investigate whether New York Heart Association 
      (NYHA) functional class had an impact on the potential benefit from ICD therapy 
      as assessed from data stored in the memory of ICDs. METHODS AND RESULTS: Between 
      1989 and 1996, 603 patients (77% men; 59% with coronary artery disease and 16% 
      with dilated cardiomyopathy; age, 57+/-13 years; ejection fraction, 44+/-18%) 
      were treated with an ICD with extended memory function (storage of electrograms 
      and/or RR intervals from treated episodes) in combination with endocardial lead 
      systems. The stages of heart failure (NYHA functional class I through III) at 
      implantation were correlated with overall mortality and the recurrence of fast 
      ventricular tachyarrhythmias (>240 bpm) during follow-up. The potential benefit 
      of the device was estimated as the difference between overall mortality and the 
      hypothetical death rate had the device not been implanted. The latter was based 
      on the recurrence of fast and, without termination by the devices, presumably 
      fatal ventricular tachyarrhythmias. In the overall group, a significant 
      difference between hypothetical death rate and overall mortality was observed 
      (13.9%, 23.5%, and 26.6% at 1, 3, and 5 years, respectively) that suggested a 
      benefit from ICD implantation. In patients in NYHA class I, the estimated 
      benefit, which increased over time, was 15.2%, 29.2%, and 35.6% after 1, 3, and 5 
      years, respectively. In patients in NYHA class II or III, the estimated benefit 
      increased until the third year (21.8% and 21.9%, respectively) and then remained 
      constant until the fifth year (22.9% and 23.8%, respectively). Even those 
      patients in NYHA class III with a history of decompensated heart failure 
      benefited from ICD implantation. CONCLUSIONS: Analysis of stored ECG data 
      suggests that in patients with a history of ventricular tachycardia or 
      ventricular fibrillation, ICD therapy may lead to a prolongation of life in NYHA 
      classes I through III. The initial benefit is greatest in patients in NYHA class 
      II and class III, but the estimated benefit might persist longest for patients in 
      NYHA class I.
FAU - Bocker, D
AU  - Bocker D
AD  - Hospital of the Westfalische Wilhelms-University of Munster, Departments of 
      Cardiology, Germany.
FAU - Bansch, D
AU  - Bansch D
FAU - Heinecke, A
AU  - Heinecke A
FAU - Weber, M
AU  - Weber M
FAU - Brunn, J
AU  - Brunn J
FAU - Hammel, D
AU  - Hammel D
FAU - Borggrefe, M
AU  - Borggrefe M
FAU - Breithardt, G
AU  - Breithardt G
FAU - Block, M
AU  - Block M
LA  - eng
PT  - Clinical Trial
PT  - Controlled Clinical Trial
PT  - Journal Article
PL  - United States
TA  - Circulation
JT  - Circulation
JID - 0147763
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiomyopathy, Dilated/mortality/*therapy
MH  - Child
MH  - *Defibrillators, Implantable
MH  - Electrocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Survival Rate
MH  - Tachycardia/therapy
MH  - Treatment Outcome
EDAT- 1998/10/20 00:00
MHDA- 1998/10/20 00:01
CRDT- 1998/10/20 00:00
PHST- 1998/10/20 00:00 [pubmed]
PHST- 1998/10/20 00:01 [medline]
PHST- 1998/10/20 00:00 [entrez]
AID - 10.1161/01.cir.98.16.1636 [doi]
PST - ppublish
SO  - Circulation. 1998 Oct 20;98(16):1636-43. doi: 10.1161/01.cir.98.16.1636.