Manuscript received 4 January 2005; Revised manuscript received 18 April 2005; Accepted for publication 20 April 2005.
Determinants of Recurrent Ventricular Arrhythmia or Death in 300 Consecutive Patients with Ischemic Heart Disease Who Experienced Aborted Sudden Death: Data from the Leiden Out-of-Hospital Cardiac Arrest Study
Article first published online: 23 JUN 2005
Journal of Cardiovascular Electrophysiology
Volume 16, Issue 10, pages 1049–1056, October 2005
How to Cite
KIÈS, P., BOERSMA, E., BAX, J. J., Van Der BURG, A. E. B., BOOTSMA, M., Van ERVEN, L., Van Der WALL, E. E. and SCHALIJ, M. J. (2005), Determinants of Recurrent Ventricular Arrhythmia or Death in 300 Consecutive Patients with Ischemic Heart Disease Who Experienced Aborted Sudden Death: Data from the Leiden Out-of-Hospital Cardiac Arrest Study. Journal of Cardiovascular Electrophysiology, 16: 1049–1056. doi: 10.1111/j.1540-8167.2005.50006.x
- Issue published online: 23 JUN 2005
- Article first published online: 23 JUN 2005
- heart arrest;
- heart failure;
- ischemic heart disease;
- ventricular arrhythmia
Objective: Evaluation of the relation between clinical characteristics and incidence of recurrent ventricular arrhythmias (VAs) or death during long-term follow-up in a cohort of 300 consecutive ischemic heart disease (IHD) patients who had survived an episode of sudden cardiac arrest (SCA).
Background: Survivors of life-threatening VA are at high risk for recurrent events.
Methods: A total of 300 consecutive survivors of SCA with IHD were included in a standardized screening and evaluation protocol. Multivariable Cox regression analysis was performed to determine the relation between clinical variables at baseline and the incidence of recurrent VA, all-cause mortality and the composite of both (composite endpoint).
Results: The presenting arrhythmia was VT in 156 (52%) patients and VF in 144 (48%) patients. Revascularization was performed in 78 (26%) patients and an ICD was implanted in 216 (72%) patients. During follow-up (mean 30 ± 21 months) 37 (12%) patients died and 88 (29%) patients experienced a recurrence. Advanced age (adjusted hazard ratio (HR) 2.0; 1.2–3.3), history of heart failure (HR 1.8; 1.2–2.6), and amiodarone use (HR 3.1; 2.1–4.6) were independent predictors for the composite endpoint. VT as presenting arrhythmia was an independent predictor for all-cause mortality only (HR 2.4; 1.2–4.8). A decreased risk of recurrences was determined by beta-blocker use (HR 0.5; 0.4–0.8) and coronary revascularization (HR 0.3; 0.2–0.6).
Conclusion: In a cohort of 300 consecutive survivors of SCA the incidence of recurrent VA and death is dependant on patient age, history of heart failure, and use of amiodarone. In contrast, use of beta-blockers and aggressive coronary revascularization improve the outcome.