Heart Failure pp 115-120 | Cite as

ICD Therapy: Can It Prevent Sudden Death in CHF Patients?

  • Ko Takeichi
  • Naoki Matsuda
  • Hiroshi Kasanuki
Conference paper


Implantable cardioverter defibrillator (ICD) therapy has greatly decreased the risk of sudden death in patients with reduced heart function. However, the ICD may be limited in improving the prognosis in these patients. More patients who received consecutive discharges died than did those patients who received only single discharges or no discharges at all. In our study, six of seven patients with severely reduced heart function who had consecutive discharges died. Treatment with only ICD therapy may be limited in improving the prognosis in these patients, and therefore we should consider using amiodarone or a β-blocker combined with ICD therapy. In our study, there was no difference in the number of patients who received ICD discharges between those treated or not treated with amiodarone plus β-blockers. However, there were no patients who received consecutive discharges or who died in the group of patients treated with amiodarone plus β-blockers. Our findings suggested that although concomitant therapy with amiodarone plus β-blockers was effective in increasing the electrical stability necessary to terminate VT/VF by a single discharge from an ICD, and this effect contributed to improving the prognosis.

Key words

Implantable cardioveter defibrillator Heart failure Amiodarone β-Blocker Sudden death 


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  1. 1.
    Packer M (1985) Sudden unexpected death in patients with congestive heart failure: a second frontier. Circulation 72: 681–685PubMedCrossRefGoogle Scholar
  2. 2.
    Narang R, Cleland JGF, Erhardt L, Ball SG, Coats AJS, Cowley AJ, Dargie HJ, Hall AS, Hampton JR, Poole-Wilson PA (1996) Mode of death in chronic heart failure. A request and proposition for more accurate classification. Eur Heart J 17: 1390–1403PubMedGoogle Scholar
  3. 3.
    Hinkel LE, Thaler HT (1982) Clinical classification of cardiac deaths. Circulation 65: 457–464CrossRefGoogle Scholar
  4. 4.
    Bayes de Luna A, Coumel P, Leclercq JF (1989) Ambulatory sudden cardiac death: mechanisms of production of fatal arrhythmia on the basis of data from 157 cases. Am Heart J 117: 151–159PubMedCrossRefGoogle Scholar
  5. 5.
    Luu M, Stevenson WG, Stevenson LW, Baron K. Walden J (1989) Diverse mechanisms of unexpected cardiac arrest in advanced heart failure. Circulation 80: 1675–1680PubMedCrossRefGoogle Scholar
  6. 6.
    The Antiarrhuthmics versus Implantable Defibrillators (AVID) Investigators (1997) A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med 337: 1576–1583Google Scholar
  7. 7.
    Bardy GH, Hofer B, Johnson G, Kudenchuk PJ, Poole JE, Dolack GL, Gleva M, Mitchell R, Kelso D (1993) Implantable transvenous cardioverter-defibrillator. Circulation 87: 1152–1168PubMedGoogle Scholar
  8. 8.
    Raviele A, Gasparini G (1995) Italian multicenter clinical experience with endocardial defibrillation: acute and long-term result in 307 patients. PACE (Pacing Clin Electrophysiol) 18: 599–608CrossRefGoogle Scholar
  9. 9.
    Fogors RN, Elson JJ, Bonnet CA, Fielder SB, Burkholder JA (1990) Efficacy of the automatic implantable cardioverter-defibrillator in prolonging survival in patients with severe underlying cardiac disease. JACC (J Am Coll Cardiol) 16: 381–386CrossRefGoogle Scholar
  10. 10.
    Sweeney MO, Ruskin JN (1994) Mortality benefits and the implantable cardioverterdefibrillator. Circulation 89: 1851–1858PubMedGoogle Scholar
  11. 11.
    Kim SG, Fisher JD, Choue CH, Gross J, Roth J, Ferrick KJ, Brodman R, Furman S (1992) Influence of ventricular function on outcome of patients treated with implantable defibrillators. Circulation 85: 1304–1310PubMedGoogle Scholar
  12. 12.
    Grimm W, Flores BT, Marchlinski FE (1993) Shock occurrence and survival in 241 patients with implantable cardioverter-defibrillator therapy. Circulation 87: 1880–1888PubMedGoogle Scholar
  13. 13.
    Levine JH, Mellits ED, Baumgardner RA, Veltri EP, Mower M, Grunwald L, Guarnieri T, Aarons D, Griffith LS (1991) Predictors of first discharge and subsequent survival in patients with automatic implantable cardioverter-defibrillators. Circulation 84: 558–566PubMedGoogle Scholar
  14. 14.
    Zilo P, Gross JN, Bendek M, Fisher JD, Furman S (1991) Occurrence of ICD shocks and patient survival. PACE 14: 273–279PubMedCrossRefGoogle Scholar
  15. 15.
    Heisel A, Neuzner J, Himmrich E, Pitschner HF, Liebrich A, Jung J, Sen S (1995) Safety of antitachycardia pacing in patients with implantable cardioverter defibrillators and severely depressed left ventricular function. PACE (Pacing Clin Electrophysiol) 18: 137–141CrossRefGoogle Scholar
  16. 16.
    Rabinovich R, Muratore C, Iglesias R, Gonzalez M, Serafrica M. Lipreandi AS (1995) Results of delivery therapy for VT or VF in patients with third generation implantable cardioverter defibrillators. PACE (Pacing Clin Electrophysiol) 18: 133–136CrossRefGoogle Scholar
  17. 17.
    Villacastin J, Almendral J, Arenal A, Albertos J, Ormaetxe J, Peinado R, Bueno H, Merino JL, Pastor A, Medina O, Tercedor L, Jimenez F, Delcan JL (1996) Incidence and clinical significance of multiple consecutive, appropriate, high-energy discharges in patients with implantable cardioverter-defibrillators. Circulation 93: 753–762PubMedGoogle Scholar
  18. 18.
    Josephson ME (1993) Evaluation of antiarrhythmic agents. In: Josephson ME (ed) Clinical cardiac electrophysiology: techniques and interpretations. Lea and Febiger, Malvern, pp 630–682Google Scholar
  19. 19.
    Manz M, Jung W, Luderitz B (1994) Interaction between drugs and devices: experimental and clinical studies. Am Heart J 127: 978–984PubMedCrossRefGoogle Scholar
  20. 20.
    Haberman RJ, Veltri EP, Mower MM (1988) The effect of amiodarone on defibrillation thereshold. J Electrophysiol 2: 415–423Google Scholar
  21. 21.
    Jung W, Manz M, Pizzulli L, Pfeiffer D, Luderitz B (1992) Effects of chronic amiodarone therapy on defibrillation threshold. Am J Cardiol 70: 1023–1027PubMedCrossRefGoogle Scholar
  22. 22.
    Dolack GL (1994) Clinical predictors of implantable cardioverter-defibrillator shocks (results of the CASCADE trial). Am J Cardiol 73: 237–241PubMedCrossRefGoogle Scholar
  23. 23.
    Huang SK (1991) Effects of long-term amiodarone therapy on the defibrillation threshold and the rate of shocks of the implantable cardioveter-defibrillator. Am Heart J 122: 720PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 2000

Authors and Affiliations

  • Ko Takeichi
    • 1
  • Naoki Matsuda
    • 1
  • Hiroshi Kasanuki
    • 1
  1. 1.Department of Cardiology, The Heart Institute of JapanTokyo Women’s Medical UniversityShinjuku-ku, TokyoJapan

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