Meta-analysis of Risk of Ventricular Arrhythmias After Improvement in Left Ventricular Ejection Fraction During Follow-Up in Patients With Primary Prevention Implantable Cardioverter Defibrillators

2017 ◽  
Vol 120 (2) ◽  
pp. 279-286 ◽  
Author(s):  
Aiman Smer ◽  
Alok Saurav ◽  
Muhammad Soubhi Azzouz ◽  
Mohsin Salih ◽  
Mohamed Ayan ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Left Ventricular Ejection Fraction ◽  
Ventricular Arrhythmias ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Implantable Cardioverter Defibrillators ◽  
Ventricular Ejection Fraction ◽  
Cardioverter Defibrillators

scholarly journals Ventricular Arrhythmias Among Patients With Advanced Heart Failure: A Population‐Based Study

2021 ◽  
Author(s):  
Nicholas Y. Tan ◽  
Veronique L. Roger ◽  
Jill M. Killian ◽  
Yong‐Mei Cha ◽  
Peter A. Noseworthy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Ventricular Ejection Fraction ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Advanced Heart Failure ◽  
Left Ventricular Ejection ◽  
Implantable Cardioverter Defibrillators ◽  
Ventricular Ejection Fraction ◽  
Cardioverter Defibrillators ◽  
New Onset

Background The epidemiology of ventricular arrhythmias (VAs) in patients with advanced heart failure (HF) is not well defined. Methods and Results Residents of Olmsted County, Minnesota, with advanced HF from 2007 to 2017 were identified using the 2018 European Society of Cardiology criteria. Billing codes were used to capture VAs; severe VAs requiring emergency care were defined as events associated with emergency department visits or hospitalizations. The cumulative incidence of VAs postadvanced HF was estimated with the Kaplan–Meier method. Multivariable Cox analyses were used to determine the following: (1) Predictors of severe VAs postadvanced HF; and (2) Impact of severe VAs on mortality. Of 936 patients with advanced HF, 261 (27.9%) had a history of VA. The 1‐year cumulative incidence of severe VAs postadvanced HF was 5.4%. Prior VAs (hazard ratio [HR] 2.22 [95% CI, 1.26–3.89], P =0.006) and left ventricular ejection fraction <40% (HR, 3.79 [95% CI, 1.72–8.39], P <0.001) were independently associated with increased severe VA risk postadvanced HF. New‐onset severe VAs were associated with increased mortality (HR, 4.41 [95% CI, 2.80–6.94]; P <0.001), whereas severe VAs in patients with prior VAs had no significant association with mortality risk (HR, 1.08 [95% CI, 0.65–1.78]; P =0.77). Severe VAs were associated with increased mortality in patients without implantable cardioverter defibrillators (HR, 4.89 [95% CI, 2.89–8.26]; P <0.001), but not in patients with implantable cardioverter defibrillators (HR, 1.42 [95% CI, 0.92–2.19]; P =0.11). Conclusions Patients with left ventricular ejection fraction <40% and prior VAs have increased risk of severe VA postadvanced HF. New‐onset severe VAs or severe VAs without implantable cardioverter defibrillators postadvanced HF are associated with increased mortality.

scholarly journals Clinical effectiveness of primary prevention implantable cardioverter-defibrillators: results of the EU-CERT-ICD controlled multicentre cohort study

2020 ◽  
Vol 41 (36) ◽  
pp. 3437-3447 ◽  
Author(s):  
Markus Zabel ◽  
Rik Willems ◽  
Andrzej Lubinski ◽  
Axel Bauer ◽  
Josep Brugada ◽  
...  
Keyword(s):  
Cohort Study ◽  
Primary Prevention ◽  
Clinical Effectiveness ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Chronic Obstructive ◽  
Implantable Cardioverter Defibrillators ◽  
Icd Implantation ◽  
Ventricular Ejection Fraction ◽  
Cardioverter Defibrillators

Abstract Aims The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter-Defibrillators (EU-CERT-ICD), a prospective investigator-initiated, controlled cohort study, was conducted in 44 centres and 15 European countries. It aimed to assess current clinical effectiveness of primary prevention ICD therapy. Methods and results We recruited 2327 patients with ischaemic cardiomyopathy (ICM) or dilated cardiomyopathy (DCM) and guideline indications for prophylactic ICD implantation. Primary endpoint was all-cause mortality. Clinical characteristics, medications, resting, and 12-lead Holter electrocardiograms (ECGs) were documented at enrolment baseline. Baseline and follow-up (FU) data from 2247 patients were analysable, 1516 patients before first ICD implantation (ICD group) and 731 patients without ICD serving as controls. Multivariable models and propensity scoring for adjustment were used to compare the two groups for mortality. During mean FU of 2.4 ± 1.1 years, 342 deaths occurred (6.3%/years annualized mortality, 5.6%/years in the ICD group vs. 9.2%/years in controls), favouring ICD treatment [unadjusted hazard ratio (HR) 0.682, 95% confidence interval (CI) 0.537–0.865, P = 0.0016]. Multivariable mortality predictors included age, left ventricular ejection fraction (LVEF), New York Heart Association class &lt;III, and chronic obstructive pulmonary disease. Adjusted mortality associated with ICD vs. control was 27% lower (HR 0.731, 95% CI 0.569–0.938, P = 0.0140). Subgroup analyses indicated no ICD benefit in diabetics (adjusted HR = 0.945, P = 0.7797, P for interaction = 0.0887) or those aged ≥75 years (adjusted HR 1.063, P = 0.8206, P for interaction = 0.0902). Conclusion In contemporary ICM/DCM patients (LVEF ≤35%, narrow QRS), primary prophylactic ICD treatment was associated with a 27% lower mortality after adjustment. There appear to be patients with less survival advantage, such as older patients or diabetics.

P6329123-Iodine Metaiodobenzylguanitidine imaging: a useful prognostic marker of cardiovascular death in heart failure patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L I Birtolo ◽  
P Scarparo ◽  
N Salvi ◽  
V Frantellizzi ◽  
S Cimino ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Ventricular Arrhythmias ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Abstract Background According to guidelines, implantable cardioverter defibrillator (ICD) is recommended in prevention of sudden cardiac death (SCD) in heart failure (HF) patients (pts). Guidelines have several limitations because ICD indication is based mainly on left ventricular ejection fraction (LVEF). Recently, 123-iodine metaiodobenzylguanidine imaging (123-I MIBG) seems to identify, independently from LVEF, pts at high risk of SCD: heart/mediastinum (H/M) ratio<1.6 and summed score (SS)>26. Purpose The aim is to assess the role of 123-I MIBG to predict malignant ventricular arrhythmias (VA) in HF pts Methods We enrolled 208 pts, admitted to our hospital with diagnosis of HF and LVEF≤35%, NYHA class II and III, who underwent 123-I MIBG imaging. H/M ratio of 1.6 was used as a cut-off to identify high risk (G1) versus low risk pts (G2). All pts underwent ICD implantation. Follow-up was performed at 24 months. Results 138 patients were included in G1 and 70 patients in G2. All baseline characteristics were similar in the two groups (table 1). At 24 months follow-up VA events were recorded greater in G1 compared to G2 (21% vs 10%, p=0.04). Table 1 G1 G2 P value H/M ≤1.6 (N=138) H/M >1.6 (N=70) Age (years) 65±12 63±14 0.28 Male, N (%) 108 (78) 64 (91) 0.02 Diabetes mellitus type II, N (%) 54 (39) 14 (20) 0.01 Dyslipidemia, N (%) 58 (42) 30 (42) 0.64 LVEF (%) 30±5 31±4 0.14 Ischaemic CM, N (%) 85 (62) 30 (42) 0.012 Malignant VA, N (%) 30 (21) 7 (10) 0.04 SS 38±9 16±7 0.0001 H/M: heart mediastinum ratio; LVEF: left ventricular ejection fraction; CM: cardiomyopathy; VA: ventricular arrhythmias; SS: summed score. Conclusion Our results seem to confirm that 123-I MIBG uptake is associated with the occurrence of life-threatening VA in HF pts independently from LVEF. The use of 123-I MIBG could be a useful tool in the future to increase the specificity of the pts selection for ICD therapy.

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