scholarly journals Right bundle branch block and male sex may help predict appropriate ICD therapies in patients with non-ischemic dilated cardiomyopathy and a prophylactic implantable cardioverter defibrillator

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Amores Luque ◽  
M Jimenez-Blanco Bravo ◽  
C Parra Esteban ◽  
G.L Alonso Salinas ◽  
J Alvarez Garcia ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Right Bundle Branch Block ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Bundle Branch Block ◽  
Cox Regression Analysis ◽  
Device Infection ◽  
Male Sex ◽  
Baseline Characteristics

Abstract Background Previous studies have shown that prophylactic implantable cardioverter-defibrillators (ICD) in patients with symptomatic severe systolic dysfunction reduce all-cause mortality. However, their benefit in patients with severe systolic dysfunction of non-ischemic origin is not so clear, and is currently under debate. Methods/Aim We retrospectively reviewed all consecutive patients with nonischemic dilated cardiomyopathy (NICM) who underwent prophylactic ICD implantation between 2008 and 2020 in two tertiary centers. Our main goal was to identify predictors of appropriate ICD therapies (ATP and/or shocks) in this cohort of patients. Results A total of 224 patients were included, median age 62.7 years, 73.7% men. During a median follow-up of 51 months, 61 patients (27.2%) required appropriate ICD intervention, 7 patients (3.1%) presented inappropriate shocks and 11 (4.9%) had device infection. Patients that received appropriate ICD therapies, as compared to those who did not, were more frequently men (86.9% vs 68.7%, p=0.006) and were significantly younger (median age 58.7 years, IQR 53.0–64.8 vs 63.7, IQR 57.0–69.8; p=0.02). Left ventricular end diastolic volume (LV-EDV) and left ventricular end systolic volume (LV-ESV) were both significantly higher in this subgroup of patients (median LVEDV 100 ml/m2 vs 86, p=0.0106; median LVESV 72.2 ml/m2 vs 60.9, p=0.0467). A trend towards lower LVEF was also noted, but it did not reach statistical significance (26% vs 29%, p=0.077). Regarding ECG previous to implant, patients that required ICD intervention presented more frequently complete right bundle branch block (RBBB) (14.8% vs 4.3%, p=0.007). On the other hand, left bundle branch block (LBBB) was more frequent in those patients who did not receive ICD intervention during follow-up (47.2% vs 26.2%, p=0.005). Table 1 summarizes baseline characteristics and results. In a multivariate Cox regression analysis, RBBB (HR 3.9, CI 95% 1.9–8.0, p<0.001) and male sex (HR 2.38, CI 95% 1.07–5.28, p=0.034) were identified as independent predictors of appropriate ICD therapies (Figure 2). Conclusion RBBB and male sex may help identify patients with NICM at high-risk of ventricular arrhythmias requiring ICD intervention. FUNDunding Acknowledgement Type of funding sources: None. Baseline characteristics and results Kaplan-Meier curves

scholarly journals A rare complication of implantable cardiac defibrillator placement

2020 ◽  
Author(s):  
João Ferreira ◽  
Célia Marques Domingues ◽  
Susana Isabel Costa ◽  
Maria Fátima Franco Silva ◽  
Lino Manuel Martins Gonçalves
Keyword(s):  
Heart Failure ◽  
Right Bundle Branch Block ◽  
Left Ventricular Systolic Dysfunction ◽  
Rare Complication ◽  
Systolic Dysfunction ◽  
Lateral Wall ◽  
Left Ventricular ◽  
Refractory Ascites ◽  
Bundle Branch Block ◽  
Block Pattern

Abstract Background Implantable cardiac defibrillators (ICD) are a popular and effective option in heart failure with left ventricular systolic dysfunction patients. Although frequently underdiagnosed, inadvertent malposition can lead to endocardial damage and thrombotic events. As ICD implants tend to increase in the following years, the recognition of their complications is critical. Case presentation The authors present a case of a 64-year-old woman with advanced heart failure and ICD malposition. This accidental discovery was denounced by the presence of a right bundle branch block pattern and later confirmed by echocardiography which showed the lead tip in contact with the mid segment of the left ventricular antero-lateral wall. As the patient hospitalisation was complicated with refractory ascites and cardiogenic shock, she underwent cardiac transplantation, with no recurrence of heart failure symptoms. Conclusions An electrocardiogram showing a right bundle branch block pattern during VVI pacing should arise the suspicion of inadvertent placement of a pacing/ICD lead. The many facets of echocardiography should be used for the diagnosis of this complication, as they were paramount in this case, as highlighted.

Abstract 4188: Prognostic implications of Ischemic Myocardial Scar by Cardiac Magnetic Resonance in Patients with Normal Coronary Angiography and Dilated Cardiomyopathy

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Alfonso Valle ◽  
Miguel Corbi ◽  
Mercedes Nadal ◽  
Jordi Estornell ◽  
Elena Lucas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Magnetic Resonance ◽  
Dilated Cardiomyopathy ◽  
Event Rate ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Prognostic Implications ◽  
Lge Cmr

Background . In patients (pts) with chronic heart failure, late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) is capable to distinguish left ventricular systolic dysfunction (LVSD) related or not to coronary artery disease (CAD). Moreover about 10% of pts with dilated cardiomyopathy (DCM) are actually «unrecognized » ischemic cardiomyopathy (ICM), possibly because of coronary recanalization after silent infarction. However, the prognostic implications of « unrecognized » ICM are not known. Methods. Three hundred consecutive pts with heart failure and LVSD underwent LGE-CMR and were followed prospectively during 833 days (12–2724). The primary endpoint was the composite of cardiac death or heart failure hospitalization. Pts were classified into 4 groups : DCM without LGE (N 149) ; DCM with midwall fibrosis (n 35) ; ICM : ischemic scar and CAD (n 81) ; « unrecognized » ICM : ischemic scar without CAD (n 30). Results. 111 pts (38%) experienced events during follow-up.. There were non significant differences in event rate in patients with « unrecognized » ICM and ICM (53% and 63% respectively). By contrast the event rate in ICM groups were significantly higher than in pts with DCM (29% in group 1 and 31% in group 2 ; p = 0.000001) (Figure ). By multivariate analysis LGE was the strongest predictor of cardiac events (HR 1,7 CI 95% 1.07–2.88). Conclusions . In our series, pts with « unrecognized » ICM detected by CMR had a high risk of cardiac events during follow up similar to those pts with ICM. These findings had potentially important implications for routine use of CMR as a diagnostic and prognostic tool in patients with heart failure and systolic dysfunction.

scholarly journals Prognostic impact of right bundle branch block in hospitalized patients with idiopathic dilated cardiomyopathy: a single-center cohort study

2018 ◽  
Vol 48 (1) ◽  
pp. 030006051880147 ◽  
Author(s):  
Li Lai ◽  
Rong Jiang ◽  
Wei Fang ◽  
Chao Yan ◽  
Yibin Tang ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Dilated Cardiomyopathy ◽  
Right Bundle Branch Block ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Hospitalized Patients ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Prognostic Impact ◽  
Bundle Branch Block ◽  
All Cause Mortality

Objective Idiopathic dilated cardiomyopathy (IDCM) is a primary myocardial disease resulting in symptoms of heart failure. Right bundle branch block (RBBB) is associated with increased cardiovascular risk and all-cause mortality. Therefore, the present study was performed to identify the prognostic impact of RBBB in patients with IDCM. Methods In total, 165 hospitalized patients with IDCM were evaluated. Receiver operating characteristic curve analysis was used to determine the cutoff point, and Cox regression was used to assess risk factors. Results After a median follow-up of 73.1 months (interquartile range, 36.1–88.7 months), 59 (35.8%) patients had died. All-cause mortality was significantly higher in patients with than without RBBB (log-rank χ2 = 9.400), P<0.05. Significant independent predictors of all-cause mortality in patients with IDCM were RBBB (hazard ratio, 2.898; 95% confidence interval, 1.201–6.995) and the left ventricular end-diastolic dimension (LVEDD) (hazard ratio, 1.034; 95% confidence interval, 1.004–1.066) at admission. Patients with RBBB and an LVEDD of ≥63 mm had the highest mortality (log-rank χ2 = 14.854), P<0.05. Conclusion RBBB was an independent predictor of all-cause mortality, and the combination of RBBB and LVEDD provided more clinically relevant information than RBBB alone for assessing the risk of all-cause mortality in patients with IDCM.

scholarly journals Clinical Determinants and Prognosis of Left Ventricular Reverse Remodelling in Non-Ischemic Dilated Cardiomyopathy

2022 ◽  
Vol 9 (1) ◽  
pp. 20
Author(s):  
Carles Díez-López ◽  
Joel Salazar-Mendiguchía ◽  
Elena García-Romero ◽  
Lara Fuentes ◽  
Josep Lupón ◽  
...  
Keyword(s):  
Dilated Cardiomyopathy ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Clinical Predictors ◽  
Treatment Optimization ◽  
Ventricular Ejection Fraction ◽  
Reverse Remodelling

Aims: Non-ischaemic dilated cardiomyopathy (NIDCM) is characterized by left ventricular (LV) chamber enlargement and systolic dysfunction in the absence of coronary artery disease. Left ventricular reverse remodelling (LVRR) is the ability of a dilated ventricle to restore its normal size, shape and function. We sought to determine the frequency, clinical predictors and prognostic implications of LVRR, in a cohort of heart failure (HF) patients with NIDCM. Methods: We conducted a multicentre observational, retrospective cohort study of patients with NIDCM, with prospective serial echocardiography evaluations. LVRR was defined as an increase of ≥15% in left ventricular ejection fraction (LVEF) or as a LVEF increase ≥ 10% plus reduction of LV end-systolic diameter index ≥ 20%. We used multivariable logistic regression analyses to identify the baseline clinical predictors of LVRR and evaluate the prognostic impact of LVRR. Results: LVRR was achieved in 42.5% of 527 patients with NIDCM during the first year of follow-up (median LVEF 49%, median change +22%), Alcoholic aetiology, HF duration, baseline LVEF and the absence of LBBB (plus NT-proBNP levels when in the model), were the strongest predictors of LVRR. During a median follow-up of 47 months, 134 patients died (25.4%) and 7 patients (1.3%) received a heart transplant. Patients with LVRR presented better outcomes, regardless of other clinical conditions. Conclusions: In patients with NIDCM, LVRR was frequent and was associated with improved prognosis. Major clinical predictors of LVRR were alcoholic cardiomyopathy, absence of LBBB, shorter HF duration, and lower baseline LVEF and NT-proBNP levels. Our study advocates for clinical phenotyping of non-ischaemic dilated cardiomyopathy and intense gold-standard treatment optimization of patients according to current guidelines and recommendations in specialized HF units.

P1464A question of gender equality. Sex-related differences in survival after primary prevention implantable cardioverter-defibrillator implantation for dilated cardiomyopathy An analysis from POLKARD

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
I Warchol ◽  
A Lubinski ◽  
M Sterlinski ◽  
O Kowalski ◽  
K Goscinska-Bis ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Dilated Cardiomyopathy ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Implantable Cardioverter Defibrillators ◽  
Protective Effects ◽  
Consistent Finding ◽  
Cardioverter Defibrillator ◽  
Kaplan Meier

Abstract OnBehalf POLKARD Polish ICD Registry Background The protective effects of implantable cardioverter defibrillators (ICDs) in the primary prevention of sudden cardiac death of patients presenting with left ventricular (LV) systolic dysfunction are unequivocal. Nevertheless, female underrepresentation has been a consistent finding in all randomized controlled primary prevention ICD trials. Surprisingly, there is a vast body of literature on female primary prevention ICD patients exhibit a lower overall mortality. Purpose Therefore, we analyzed data from a large, nationwide POLKARD registry to evaluate the effect of sex on survival after primary prevention cardioverter-defibrillator implantation for dilated cardiomyopathy. Methods All patients enrolled in the Polish ICD Registry from 2008 to 2014 were identified. Patients were included in the study if they were designated as receiving an ICD for primary prevention of SCD after documented non-ischeamic cardiomyopathy. Kaplan-Meier survival analysis was used to assess all-cause mortality. Results Of the 964 ICD recipients, 241 (25%) were women (mean age of 64± 0,45 years). During a mean follow-up of 5,53 ± 2,48 years 32% of women and 42% of men died. Kaplan-Meier curve depicted a significantly lower mortality for women than for men (p = 0,05). The median survival time was 6,73 years (55 deaths per 1000 person-years) versus 6,37 years (78 deaths per 1000 person-years) for women and men, respectively. Conclusions In agreement with previous studies, our data indicate that primary prevention implantation rates for dilated cardiomyopathy are lower in women. However, the reasons are not entirely understood.

Atypical Takotsubo Cardiomyopathy with Hypokinetic Left Mid-ventricle and Apical Wall Sparing: A Case Report and Literature Review

2020 ◽  
Vol 16 (3) ◽  
pp. 241-246
Author(s):  
Dipesh Ludhwani ◽  
Belaal Sheikh ◽  
Vasu K Patel ◽  
Khushali Jhaveri ◽  
Mohammad Kizilbash ◽  
...  
Keyword(s):  
Case Report ◽  
Takotsubo Cardiomyopathy ◽  
Systolic Dysfunction ◽  
Obstructive Coronary Artery Disease ◽  
Left Ventricular ◽  
Reduced Ejection Fraction ◽  
Coronary Syndrome ◽  
Normal Left Ventricular ◽  
Artery Disease

Background: Takotsubo Cardiomyopathy (TTC) is an uncommon cause of acute reversible ventricular systolic dysfunction in the absence of obstructive Coronary Artery Disease (CAD). Typically manifesting as apical wall ballooning, TTC can rarely present atypically with apical wall sparing. Case report: A 62-year-old female presented with complaints of chest pain and features mimicking acute coronary syndrome. Coronary angiogram revealed no obstructive CAD and left ventriculogram showed reduced ejection fraction, normal left ventricular apex and hypokinetic mid-ventricles consistent with atypical TTC. The patient was discharged home on heart failure medications and a follow-up transthoracic echocardiogram demonstrated improved left ventricular function with no wall motion abnormality. Conclusion: This case report provides an insight into the diagnosis and management of TTC in the absence of pathognomic features.

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