TY - JOUR
T1 - ICD-implantation guidelines versus clinical practice: a prospective study of out-of-hospital cardiac arrest survivors
AU - Sterk, B.
AU - van Alem, A. P.
AU - Tukkie, R.
AU - Simmers, T. A.
AU - Koster, R. W.
PY - 2004
Y1 - 2004
N2 - Aims The aim of this study was prospectively to compare clinical practice of implantable cardioverter defibrillator (ICD) use with current guidelines in out-of-hospitat cardiac arrest (OHCA) survivors. Methods and results From January 2000 till March 2002, 70 consecutive patients (pts) discharged from 15 hospitals after OHCA, with ventricular fibrillation (VF) as initial rhythm were included. Documentation of diagnosis, left ventricular function, ischaemia, electrophysiotogical studies (EPS), and decisions regarding ICD resuscitation implantation were obtained from medical records. An expert committee compared these data with current guidelines. According to these guidelines 18 pts (26%) had an ICD indication and received an ICD white 37 pts (53%) had no indication and did not receive an ICD. In 13 pts without acute myocardial infarction insufficient diagnostic procedures were performed to permit a decision on ICD indication, hence no ICD was implanted. Two pts had an ICD indication but did not receive an ICD. During the follow-up with duration of 25 months (range 12-38 months), two sudden deaths occurred in the group of pts without an ICD. Of the pts with an ICD, 4 pts (22%) were reported to have received one or more shocks for VT/VF. Conclusion In at least 21% of OHCA survivors, insufficient diagnostic procedures concerning the indication for ICD implantation were performed or no ICD was implanted when indicated, despite clear guidelines. In particular, there was no proof of ischaemia prior to revascularization and no confirmation of the absence of ischaemia and EPS thereafter. Clinicians should be guided better in evaluating pts after OHCA concerning the indication for ICD implantation, especially when a transient of reversible condition was present or when treatment was sufficiently established safety to refrain from ICD implantation. (C) 2004 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved
AB - Aims The aim of this study was prospectively to compare clinical practice of implantable cardioverter defibrillator (ICD) use with current guidelines in out-of-hospitat cardiac arrest (OHCA) survivors. Methods and results From January 2000 till March 2002, 70 consecutive patients (pts) discharged from 15 hospitals after OHCA, with ventricular fibrillation (VF) as initial rhythm were included. Documentation of diagnosis, left ventricular function, ischaemia, electrophysiotogical studies (EPS), and decisions regarding ICD resuscitation implantation were obtained from medical records. An expert committee compared these data with current guidelines. According to these guidelines 18 pts (26%) had an ICD indication and received an ICD white 37 pts (53%) had no indication and did not receive an ICD. In 13 pts without acute myocardial infarction insufficient diagnostic procedures were performed to permit a decision on ICD indication, hence no ICD was implanted. Two pts had an ICD indication but did not receive an ICD. During the follow-up with duration of 25 months (range 12-38 months), two sudden deaths occurred in the group of pts without an ICD. Of the pts with an ICD, 4 pts (22%) were reported to have received one or more shocks for VT/VF. Conclusion In at least 21% of OHCA survivors, insufficient diagnostic procedures concerning the indication for ICD implantation were performed or no ICD was implanted when indicated, despite clear guidelines. In particular, there was no proof of ischaemia prior to revascularization and no confirmation of the absence of ischaemia and EPS thereafter. Clinicians should be guided better in evaluating pts after OHCA concerning the indication for ICD implantation, especially when a transient of reversible condition was present or when treatment was sufficiently established safety to refrain from ICD implantation. (C) 2004 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved
U2 - https://doi.org/10.1016/j.eupc.2004.01.001
DO - https://doi.org/10.1016/j.eupc.2004.01.001
M3 - Article
C2 - 15121066
SN - 1099-5129
VL - 6
SP - 179
EP - 183
JO - Europace : European pacing, arrhythmias, and cardiac electrophysiology
JF - Europace : European pacing, arrhythmias, and cardiac electrophysiology
IS - 3
ER -