• Annika Kinch Westerdahl, Johanna Sjöblom, Anne-Cathrine Mattiasson, Mårten Rosenqvist, and Viveka Frykman.
• Department of Clinical Sciences, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden (A.K.W., J.S., M.R., V.F.) and the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden (A.-C.M.).
• Circulation. 2014 Jan 28; 129 (4): 422-9.

BackgroundSeveral trials have demonstrated improved survival with implantable cardioverter-defibrillator (ICD) therapy. The cause and nature of death in the ICD population have been insufficiently investigated. The objective of this study was to analyze ICDs from deceased patients to assess the incidence of ventricular tachyarrhythmias, the occurrence of shocks, and possible device malfunction.Methods And ResultsWe prospectively analyzed intracardiac electrograms in 125 explanted ICDs. The incidence of ventricular tachyarrhythmia, including ventricular fibrillation, and shock treatment was assessed. Ventricular tachyarrhythmia occurred in 35% of the patients in the last hour of their lives; 24% had an arrhythmic storm, and 31% received shock treatment during the last 24 hours. Arrhythmic death was the primary cause of death in 13% of the patients, and the most common cause of death was congestive heart failure (37%). More than half of the patients (52%) had a do-not-resuscitate order, and 65% of them still had the ICD shock therapies activated 24 hours before death. Possible malfunctions of the ICD were found in 3% of all patients.ConclusionsMore than one third of the patients had a ventricular tachyarrhythmia within the last hour of life. Cardiac death was the primary cause and heart failure the specific cause of death in the majority of the cases. Devices remained active in more than half of the patients with a do-not-resuscitate order; almost one fourth of these patients received at least 1 shock in the last 24 hours of life.

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