NEW YORK (Reuters) -- Implantable cardioverter-defibrillators (ICDs) help reduce the rate of sudden cardiac death for patients with potentially fatal arrhythmias, report researchers in the Journal of the American College of Cardiology. But because syncope, or fainting, and other symptoms may still occur, these patients often live with limitations, including restrictions on driving.
Dr. Dietmar Bansch and fellow researchers from Westfallische Wilhems University in Germany examined 421 patients with ICDs to determine the occurrence, risk prediction and prevention of fainting. They determined that it is possible to determine which patients with an ICD have a high risk of syncope, a factor that would help to determine which patients need driving restrictions imposed.
Specifically, Bansch and his colleagues found that "...occurrence of syncope is a frequent clinical problem in patients with an ICD. More than one third of patients with recurrent (ventricular tachycardia) will have at least one episode of syncope, and almost half of these (44%) will have a second episode during three years of follow-up." Ten percent of patients studied experienced fainting in the first year of ICD therapy, 5% in the second year, and 4% in the third year.
"Major predictors of syncope are a low (left ventricular) ejection fraction, inducible fast VT (ventricular tachycardia) and chronic AF (atrial fibrillation)," the investigators explain. "After the first recurrence of VT, major risk predictors of future syncope are a fast heart rate or syncope at first VT."
"Recommendations for patients' daily lives should be based on risk stratification and follow up," the authors conclude.
SOURCE: Journal of the American College of Cardiology (1998;31:608-615)
