The implantable automatic defibrillator has proved its superiority over pharmacological treatments for preventing mortality by serious ventricular arrhythmia. We studied the cause of death in a population of 283 consecutive patients implanted between February 1988 and December 2000 (age at implantation: 58 +/- 14.7 years; extremes: 15-78 years, 45 females, ejection fraction: 0.39 +/- 0.15) and followed up over a median of 25 months (extremes = 1 day-163 months).
Results: At the end of follow up, 55 patients had died (average age: 62.7 +/- 12.6 years, extremes: 15-79 years, 7 females). All except 2 had a cardiopathy: ischaemic cardiopathy (n = 38, 36 IDDM), dilated cardiomyopathy (n = 14), arrhythmogenic dysplasia of the right ventricle (n = 1). The median interval between implantation and death was 35 months (extremes = 1 day-137 months). The causes of death were the following: cardiac insufficiency (n = 24), refractory arrhythmias (n = 13), other cardiac causes (n = 8), extra-cardiac pathologies (n = 10). The deceased patients had presented an average of 86.6 +/- 23.4 ventricular arrhythmias (extremes = 0-1309) but 18 of them (33%) did not present any during follow up.
Conclusions: Cardiac insufficiency is the prime cause of death in refractory arrhythmias; on patient in 4 dies from ventricular arrhythmia, despite the defibrillator and one deceased patient in 3 had no arrhythmia during follow up.