The epidemiology of ventricular arrhythmias

Abstract

Five research methods were adopted to explore the epidemiology of ventricular arrhythmias and provide the context for decisions about the use of implantable Cardioverter Defibrillators (ICDs): (1) A systematic review, (2) An analysis of the national database of ICDs, (3) A national survey of UK ICD centres, (4) A population based cohort study of the incidence and prognosis of patients diagnosed with ventricular arrhythmias and (5) A case series of sudden cardiac death (SCD).

Findings were as follows: No UK studies on the incidence of ventricular arrhythmias had been published prior to this work.  An assessment of the relationship between ICD use and need, suggested that those English regional areas in most need also had the lowest rates of ICD implantation.  Respondents to a national survey of ICD centres perceived patient identification as the greatest barrier to ICD use.

The incidence rate (2001-2002) of diagnosed ventricular arrhythmias was estimated as 202 (95% Cls 164, 248) per million population for all patients who had survived the first day after their diagnosis and 88% of these patients survived to 12 months.  Incidence was two fold higher in males than females and significantly increased with age.  Most patients presented with syncope or palpitations.

Expert opinion was that less than 1% of the SCD case series could have been identified prior to their death and considered for an ICD.  46% of cases would have required further investigations to determine ICD appropriateness.  Most of these cases had suffered an MI and/or were diagnosed with heard failure during their lifetime but were not referred for heart rhythm monitoring.

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