scholarly journals Looking for appropriate criterias for SCD prevention: prognostic role of MRI in patients with nonischemic ventricular arrhythmias

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B Berdibekov ◽  
S Aleksandrova ◽  
N Bulaeva ◽  
O Gromova ◽  
E Golukhova
Keyword(s):  
Regression Analysis ◽  
Risk Stratification ◽  
Secondary Prevention ◽  
Implantable Cardioverter Defibrillator ◽  
Primary Endpoint ◽  
Ventricular Arrhythmias ◽  
Interobserver Variability ◽  
Independent Predictor ◽  
Icd Therapy ◽  
Cardioverter Defibrillator

Abstract Background Currently left ventricular ejection fraction (LVEF) remains the only indicator for identifying candidates for implantable cardioverter-defibrillator (ICD)therapy for the primary prevention of sudden cardiac death (SCD). However the majority of patients suffering SCD have a preserved LVEF and some of them with poor LVEF do not benefit from ICD therapy. Late gadolinium enhancement (LGE) on cardiac-MRI (CMR) has been proposed as an independent predictor of ventricular arrhythmias. Limited data exist on the role and methods of LGE quantification in patients with a nonischemic ventricular arrhythmias. Purpose The goal of this study is to explore whether theextent of LGE would improve risk stratification in patients with a nonischemic ventricular arrhythmias with an indication for implantable cardioverter-defibrillator (ICD) therapy for the primary or secondary prevention of SCD. Methods Fifty six patients with a nonischemic ventricular arrhythmias underwent LGE-CMR prior to ICD implantation for primary and secondary prevention of SCD. LGE extent was quantified using both the full-width half-maximum (FWHM) andthe standard deviation–based (2-SD) method. The primary endpoint was appropriate ICD discharge for sustained ventricular tachyarrhythmia. Results During a median follow-up of 18 [11,5–26,0] months the primary endpoint occurred in 22 patients. The median percentage of LV myocardium fibrosis assessed by the 2-SD method was 9,8 [6,0–18,8]%, while for the FWHM method it was 5,1 [3,0–10,6]% (p<0,001). Intra-observer and inter-observer variability of the FWHM technique was excellent, intraclass correlation coefficients (ICC) 0,97 (95% CI: 0,92–0,99) for intraobserver variability and 0,95 (95% CI: 0,85–0,98) for interobserver variability. The ICC for the 2-SD method were lower: 0,92 (95% CI: 0,76–0,97) and 0,90 (95% CI: 0,69–0,96), for intra- and interobserver variability, respectively. By Cox univariate regression analysis, past syncope, HR: 3,14; (CI: 1,28–7,73), past sustained VT, HR: 8,24; (CI: 2,43–27,96), the presence of LBBB before implantation cardiac resynchronization therapy defibrillator (CRT-D), HR: 0,22; (CI: 0,05–0,96) as well as extent of LGE, HR: 1,067; per 1% increase in the extent of LGE, (CI: 1,029–1,107) demonstrated the strongest association with the appropriate ICD discharge. In multivariate regression analysis, the history of sustained VT, HR: 9,17; (CI: 2,60–32,38; p=0,001) and the value of the extent of LGE, HR: 1,081; per 1% increase in volume of LGE, (CI: 1,034–1,131; p=0,001) demonstrated an independent association with the appropriate ICD discharge. Conclusions FWHM is the optimal semi-automated quantification method in patients with nonischemic ventricular arrhythmias, demonstrating the highest technical consistency. LGE extent is an independent predictor of adverse outcomes in patients with nonischemic ventricular arrhythmia and may have an important role in risk stratification. FUNDunding Acknowledgement Type of funding sources: None. LGE Quantification Event-Free Survival

scholarly journals Risk of subsequent ventricular arrhythmia is higher in primary prevention patients with implantable cardioverter defibrillator than in secondary prevention patients

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
You Zhou ◽  
Shuang Zhao ◽  
Keping Chen ◽  
Wei Hua ◽  
Yangang Su ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Ventricular Arrhythmia ◽  
Secondary Prevention ◽  
Implantable Cardioverter Defibrillator ◽  
Incidence Rate ◽  
Home Monitoring ◽  
Icd Therapy ◽  
Cardioverter Defibrillator ◽  
All Cause Mortality

Abstract Background Because of previous ventricular arrhythmia (VA) episodes, patients with implantable cardioverter-defibrillator (ICD) for secondary prevention (SP) are generally considered to have a higher burden of VAs than primary prevention (PP) patients. However, when PP patients experienced VA, the difference in the prognosis of these two patient groups was unknown. Methods The clinical characteristics and follow-up data of 835 ICD patients (364 SP patients and 471 PP patients) with home monitoring feature were retrospectively analysed. The incidence rate and risk of subsequent VA and all-cause mortality were compared between PP patients after the first appropriate ICD therapy and SP patients. Results During a mean follow-up of 44.72 ± 20.87 months, 210 (44.59%) PP patients underwent appropriate ICD therapy. In the Kaplan-Meier survival analysis, the PP patients after appropriate ICD therapy were more prone to VA recurrence and all-cause mortality than SP patients (P<0.001 for both endpoints). The rate of appropriate ICD therapy and all-cause mortality in PP patients after the first appropriate ICD therapy was significantly higher than that in SP patients (for device therapy, 59.46 vs 20.64 patients per 100 patient-years; incidence rate ratio [IRR] 2.880, 95% confidence interval [CI]: 2.305–3.599; P<0.001; for all-cause mortality, 14.08 vs 5.40 deaths per 100 patient-years; IRR 2.607, 95% CI: 1.884–3.606; P<0.001). After propensity score matching for baseline characteristics, the risk of VA recurrence in PP patients with appropriate ICD therapy was still higher than that in SP patients (41.80 vs 19.10 patients per 100 patient-years; IRR 2.491, 95% CI: 1.889–3.287; P<0.001), but all-cause mortality rates were similar between the two groups (12.61 vs 9.33 deaths per 100 patient-years; IRR 1.352, 95% CI: 0.927–1.972; P = 0.117). Conclusions Once PP patients undergo appropriate ICD therapy, they will be more prone to VA recurrence and death than SP patients.

Long-term follow-up of patients with tetralogy of Fallot and implantable cardioverter defibrillator

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Waldmann ◽  
A Bouzeman ◽  
G Duthoit ◽  
R Koutbi ◽  
F Bessiere ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Secondary Prevention ◽  
Heart Transplantation ◽  
Implantable Cardioverter Defibrillator ◽  
Tetralogy Of Fallot ◽  
Icd Therapy ◽  
Cardioverter Defibrillator ◽  
Long Term Follow Up

Abstract Background Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, and sudden cardiac death represents an important mode of death in these patients. Data evaluating the implantable cardioverter defibrillator (ICD) in this patient population remain scarce. Purpose We aimed to describe long-term follow-up of patients with TOF and ICD through a large nationwide registry. Methods Nationwide Registry including all TOF patients with an ICD initiated in 2010. The primary outcome was the first appropriate ICD therapy. Secondary outcomes included ICD-related complications, heart transplantation, and death. Clinical events were centrally adjudicated by a blinded committee. Cox proportional hazard models were used to identify predictors of appropriate ICD therapies and ICD-related complications. Results A total of 165 patients (mean age 42.2±13.3 years, 70.1% males) were included from 40 centers, including 104 (63.0%) in secondary prevention. During a median (IQR) follow-up of 6.8 (2.5–11.4) years, 78 (47.3%) patients received at least one appropriate ICD therapy, giving an annual incidence of 10.5% (7.1% and 12.5% in primary and secondary prevention, respectively, p=0.03). Overall, 71 (43.0%) patients presented with at least one complication, including inappropriate ICD shocks in 42 (25.5%) patients and lead/generator dysfunction in 36 (21.8%) patients. Among 61 (37.0%) primary prevention patients, the annual rate of appropriate ICD therapies was 4.1%, 5.3%, 9.5%, and 13.3% in patients with respectively no, one, two, or ≥ three guideline-recommended risk factors. In our cohort, QRS fragmentation was the only independent predictor of appropriate ICD therapies (HR 4.34, 95% CI 1.42–13.23), and its integration in a model with current criteria increased the area under the curve from 0.61 to 0.72 (p=0.006). No patient with left ventricular ejection fraction (LVEF) ≤35% without at least one other risk factor had appropriate ICD therapy. Patients with congestive heart failure and/or reduced LVEF had a higher risk of non-sudden death or heart transplantation (HR=11.01, 95% CI: 2.96–40.95). Conclusions Our findings demonstrate high rates of appropriate therapies in TOF patients with an ICD, including in primary prevention. The considerable long-term burden of ICD-related complications, however, underlines the need for careful candidate selection. A combination of easy-to-use criteria might improve risk stratification beyond low LVEF. Freedom from appropriate ICD therapy Funding Acknowledgement Type of funding source: None

scholarly journals Secondary prevention implantable cardioverter-defibrillator (ICD) therapy: value in octogenarians

2021 ◽  
Author(s):  
Christian Hauck ◽  
Andreas Schober ◽  
Alexander Schober ◽  
Sabine Fredersdorf-Hahn ◽  
Ute Hubauer ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Adverse Events ◽  
Secondary Prevention ◽  
Implantable Cardioverter Defibrillator ◽  
Surgical Intervention ◽  
Age Groups ◽  
Icd Implantation ◽  
Icd Therapy ◽  
Cardioverter Defibrillator ◽  
Age Related

Abstract Background Implantable cardioverter-defibrillator (ICD) therapy is well established for secondary prevention, but studies on the efficacy and safety in elderly patients are still lacking. This retrospective study compared the outcome after ICD implantation between octogenarians and other age groups. Methods Data were obtained from a local ICD registry. Patients who received ICD implantation for secondary prevention at our department were included. All-cause mortality, appropriate ICD therapy and acute adverse events requiring surgical intervention were compared between different age groups. Results 519 patients were enrolled, 34 of whom were aged ≥ 80 years. During the median follow-up of 35 months after ICD implantation 129 patients (annual mortality rate 5.0%) had died, including 16 patients aged ≥ 80 years (annual mortality rate 9.4%). The mortality rate of patients aged ≥ 80 years was significantly higher than that of patients aged ≤ 69 years (p < 0.001), but similar to that of patients aged 70–79 years. Age at the time of ICD implantation was an independent predictor of all-cause mortality (p < 0.001). 29.7% of patients had appropriate ICD therapy with no difference between age groups. Acute adverse events leading to surgical intervention were low (n = 13) and not age-related. Conclusion Age is an independent predictor of mortality after ICD implantation for secondary prevention. Mortality rates did not differ significantly between octogenarians and other elderly aged 70–79 years. Appropriate ICD therapy and acute adverse events leading to surgical intervention were not age-related. Implantable cardioverter-defibrillator therapy for secondary prevention seems to be an effective and safe treatment modality in octogenarians.

scholarly journals Long-Term Follow-Up of Patients With Tetralogy of Fallot and Implantable Cardioverter Defibrillator

Circulation ◽  
2020 ◽  
Vol 142 (17) ◽  
pp. 1612-1622 ◽  
Author(s):  
Victor Waldmann ◽  
Abdeslam Bouzeman ◽  
Guillaume Duthoit ◽  
Linda Koutbi ◽  
Francis Bessiere ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Secondary Prevention ◽  
Heart Transplantation ◽  
Implantable Cardioverter Defibrillator ◽  
Tetralogy Of Fallot ◽  
Icd Therapy ◽  
Cardioverter Defibrillator ◽  
Qrs Fragmentation

Background: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, and sudden cardiac death represents an important mode of death in these patients. Data evaluating the implantable cardioverter defibrillator (ICD) in this patient population remain scarce. Methods: A Nationwide French Registry including all patients with tetralogy of Fallot with an ICD was initiated in 2010 by the French Institute of Health and Medical Research. The primary time to event end point was the time from ICD implantation to first appropriate ICD therapy. Secondary outcomes included ICD-related complications, heart transplantation, and death. Clinical events were centrally adjudicated by a blinded committee. Results: A total of 165 patients (mean age, 42.2±13.3 years, 70.1% males) were included from 40 centers, including 104 (63.0%) in secondary prevention. During a median (interquartile range) follow-up of 6.8 (2.5–11.4) years, 78 (47.3%) patients received at least 1 appropriate ICD therapy. The annual incidence of the primary outcome was 10.5% (7.1% and 12.5% in primary and secondary prevention, respectively; P =0.03). Overall, 71 (43.0%) patients presented with at least 1 ICD complication, including inappropriate shocks in 42 (25.5%) patients and lead dysfunction in 36 (21.8%) patients. Among 61 (37.0%) patients in primary prevention, the annual rate of appropriate ICD therapies was 4.1%, 5.3%, 9.5%, and 13.3% in patients with, respectively, 0, 1, 2, or ≥3 guidelines-recommended risk factors. QRS fragmentation was the only independent predictor of appropriate ICD therapies (hazard ratio, 3.47 [95% CI, 1.19–10.11]), and its integration in a model with current criteria increased the 5-year time-dependent area under the curve from 0.68 to 0.81 ( P =0.006). Patients with congestive heart failure or reduced left ventricular ejection fraction had a higher risk of nonarrhythmic death or heart transplantation (hazard ratio, 11.01 [95% CI, 2.96–40.95]). Conclusions: Patients with tetralogy of Fallot and an ICD experience high rates of appropriate therapies, including those implanted in primary prevention. The considerable long-term burden of ICD-related complications, however, underlines the need for careful candidate selection. A combination of easy-to-use criteria including QRS fragmentation might improve risk stratification. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03837574.

scholarly journals Secondary prevention implantable cardioverter-defibrillator (ICD) therapy in octogenarians: effective and safe

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Hauck ◽  
A D Schober ◽  
A L Schober ◽  
S Fredersdorf-Hahn ◽  
U Hubauer ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Adverse Events ◽  
Secondary Prevention ◽  
Implantable Cardioverter Defibrillator ◽  
Surgical Intervention ◽  
Age Groups ◽  
Icd Implantation ◽  
Icd Therapy ◽  
Cardioverter Defibrillator ◽  
Age Related

Abstract Aims Implantable cardioverter-defibrillator is well established for secondary prevention, but there is a lack of studies showing efficacy and safety in the elderly. The current study compared the outcome of octogenarians after ICD implantation to other age groups. Methods Data was achieved from a local ICD registry. Patients who received ICD implantation for secondary prevention were included. All-cause mortality, appropriate ICD therapy and acute adverse events requiring surgical intervention were compared between different age groups. Results 519 patients were enrolled. 34 patients were ≥80 years. Over a median follow-up of 35 months after ICD implantation 129 patients (annual mortality rate 5.0%) died, including 16 patients in the age group ≥80 years (annual mortality rate 9.4%). Mortality rate in the age group ≥80 years was significantly higher than in the age groups ≤69 years (p&lt;0.001) but no difference could be seen compared to age groups 70–79 y. Age at the time of ICD implantation was an independent predictor of all-cause mortality (p&lt;0.001). 29.7% of patients had appropriate ICD therapy with no difference between age groups. Acute adverse events leading to surgical intervention were low (n=13) and not age-related. Conclusion Age is an independent predictor of mortality after ICD implantation for secondary prevention. No difference in mortality rate could be seen between octogenarians and other elderly from 70 – 79 years. Appropriate ICD therapy and acute adverse events leading to surgical intervention were not age-related. Implantable cardioverter-defibrillator for secondary prevention seems to be an effective and safe therapy in octogenarians. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Sex-specific differences in risk stratification of ventricular arrhythmias among implantable cardioverter defibrillator patients: do women differ from men?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.C.J Van Der Lingen ◽  
D.A.M.J Theuns ◽  
M.A.J Becker ◽  
A.C Van Rossum ◽  
V.P Van Halm ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Stratification ◽  
Secondary Prevention ◽  
Ventricular Arrhythmias ◽  
Study Cohort ◽  
Icd Implantation ◽  
Icd Therapy ◽  
Prevention Therapy ◽  
Male Patients

Abstract Background Implantable cardioverter defibrillator (ICD) guidelines and risk stratification models of sudden cardiac death (SCD) are applied without differentiation between men and women, based on the assumption that the incidence of ventricular arrhythmias and risk factors of SCD are similar in both sexes. Sex-specific risk factors of SCD may influence studies evaluating the benefit of ICD therapy, for both men and women. Purpose Aim of the study is to assess sex-specific differences in occurrence and predictors of appropriate device therapy (ADT) for ventricular arrhythmias. Methods A multicenter retrospective cohort of 2300 consecutive patients was evaluated, including patients referred for ICD implantation between the years 2009–2018 (age 62±13 years, LVEF 32±12%, 53% ischemic cardiomyopathy [CMP], 28% resynchronization therapy, 65% primary prevention). Exclusion criteria were: (1) patients with hypertrophic CMP, arrhythmogenic right ventricular CMP, systemic infiltrative cardiac disease or channelopathy; (2) lost to follow-up immediately after ICD implantation. Primary endpoint was ADT, defined as anti-tachycardia pacing or shock for ventricular tachyarrhythmia. Secondary endpoints were mortality and inappropriate ICD therapy. Univariable and multivariable Cox regression analyses, stratified by sex, were performed to assess predictors of ADT. Results The cohort primarily consisted of men (75%). After a mean follow-up of 4.8±3.0 years, men experienced more ADT compared to women (25% versus 16%, HR 1.71, p&lt;0.001) and men displayed a higher mortality compared to women (25% versus 19%, HR 1.37, p&lt;0.01). No difference in inappropriate ICD therapy was observed (9% versus 10%, HR 1.01, p=0.94). In the total study cohort, male sex (HR 1.55, p&lt;0.001), higher age (HR 1.15 per 10 years, p&lt;0.0019), left bundle branch block (LBBB, HR 0.74, p=0.01) and secondary prevention indication (HR 1.89, p&lt;0.001) were independently associated with ADT. In male patients, independent predictors of ADT were comparable with the total study cohort: higher age (HR 1.20 per 10 years, p&lt;0.001), LBBB (HR 0.72, p=0.01) and secondary prevention therapy (HR 1.80, p&lt;0.001). In contrast, age (p=0.54) or LBBB (p=0.29) were not associated with ADT in women. In women, only paroxysmal atrial fibrillation (HR 1.76, p=0.03) and secondary prevention therapy (HR 1.78, p&lt;0.01) were independently associated with ADT. Conclusion This study showed that men were at higher risk of ADT compared to women and that risk factors associated with SCD differ between both sexes. The results strongly suggests that SCD risk stratification models are primarily driven by male patients and sex-specific risk models of SCD are needed to identify those women at high risk of SCD. Figure 1 Funding Acknowledgement Type of funding source: None

Sign in / Sign up

Export Citation Format

Share Document