5204Primary prevention of sudden cardiac death in patients with tetralogy of Fallot with implantable cardioverter defibrillator: insights from the DAI-T4F study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Waldmann ◽  
A Bouzeman ◽  
F Bessiere ◽  
F Labombarda ◽  
M Ladouceur ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ventricular Tachycardia ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Tetralogy Of Fallot ◽  
Cardiac Death ◽  
Cardioverter Defibrillator ◽  
Programmed Ventricular Stimulation ◽  
Ventricular Stimulation

Abstract Background Ventricular arrhythmias and sudden death are feared late complications in patients with tetralogy of Fallot. Selection of candidates for primary prevention implantable cardioverter defibrillator (ICD) remains challenging in this population. Non-sustained ventricular tachycardia (NSVT), altered left ventricular ejection fraction (LVEF), positive programmed ventricular stimulation, and enlarged QRS are currently used for risk stratification. Purpose To identify high-risk patients with tetralogy of Fallot in the setting of primary prevention of sudden cardiac death. Methods The DAI-T4F study is a large ongoing national French registry including all patients with tetralogy of Fallot and ICD (NCT03837574). Information have been collected prospectively since 2010 with annual update. Baseline patient characteristics and clinical events during the follow-up were analyzed with central adjudication. Cox proportional hazard models were used to identify factors associated with appropriate ICD therapies. Results Among 134 patients enrolled, 47 (35.1%) underwent ICD implantation for primary prevention (median age 49.1 years, 76.6% males). At baseline, 20 (42.6%) patients had NSVT, 17 (36.2%) had severe altered LVEF ≤35%, 16 (34.0%) had positive programmed ventricular stimulation, and 16 (34.0%) had QRS duration ≥180ms. Overall, 20 (42.6%), 15 (31.9%), and 6 (12.8%) patients had respectively one, two, or ≥ three of these risk factors. Six (12.8%) patients were implanted for other indications. During a median (IQR) follow-up duration of 5.3 (2.1–8.0) years, 14 (29.8%) patients had at least one appropriate ICD therapy. The annual incidence of appropriate ICD therapies were 2.8%, 4.6%, 6.3%, and 8.6% in patients with none, one, two, or ≥ three of these factors (p for trend = 0.145). None of predictors, considered isolated, was significantly associated with ICD appropriate therapies. Patients with non-sustained ventricular tachycardia (NSVT) and positive programmed ventricular stimulation had a significant increased risk of ICD appropriate therapies (HR=3.8, 95% CI: 1.1–14.3, p=0.035), as well as patients with NSVT and QRSd ≥180 ms (HR=7.2, 95% CI: 1.6–32.7, p=0.003). No patient with severe altered LVEF without other risk factor had appropriate ICD therapy. Patients with congestive heart failure and/or altered LVEF had a higher risk of non-sudden death or cardiac transplantation (HR=14.4, 95% CI: 1.8–112.7, p<0.001). Seventeen (36.2%) patients experienced at least one ICD-related complication. Conclusions Our data illustrate that specific risk stratification and primary prevention for sudden cardiac death in patients with tetralogy of Fallot may be improved. The value of a severely altered LVEF appears low in the absence of other risk factors, and combination of different predictors is essential. The high rate of complications as well as consideration of competing risk situation have to be integrated in the benefit-risk equation.

scholarly journals Noninvasive programmed ventricular stimulation for prediction of future events in patients with cardioverter-defibrillator implanted for primary prevention of sudden cardiac death

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
P Futyma ◽  
P Santangeli ◽  
L Zarebski ◽  
A Wrzos ◽  
J Sander ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Predictive Value ◽  
Cardiac Death ◽  
Composite Endpoint ◽  
Cardioverter Defibrillator ◽  
Programmed Ventricular Stimulation ◽  
Ventricular Stimulation

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf The NIPS-ICD Investigators Background Implantable cardioverter-defibrillator (ICD) offers an opportunity to examine vulnerability to ventricular tachycardia (VT) or ventricular fibrillation (VF) by performing non-invasive programmed ventricular stimulation (NIPS). Whether NIPS can predict mortality in patients with primary prevention ICD, has not yet been examined. Purpose To examine a long-term predictive value of NIPS for identification of patients at increased risk of death during follow up. Methods The study group consisted of consecutive 41 patients with ICD implanted for primary prevention of sudden cardiac death, included in the prospective NIPS-ICD study (ClinicalTrials ID: NCT02373306) (34 males, age 64 ± 11 years). The patients underwent NIPS using the protocol up to three premature extrastimuli at 600, 500 and 400ms drive cycle lengths. The end-point of NIPS was induction of sustained VT or VF or completion of the protocol. Results At baseline NIPS, VT/VF was induced in 8 (20%) patients. After 5 year follow up mortality rate was significantly higher in patients who had VT/VF induced at NIPS vs no VT/VF at NIPS (38% vs 12%, p = 0.04). The difference in mortality was most remarkable at 3 (38% vs 3%, p = 0.001) and 4 years (38% vs 6%, p = 0.007). The NIPS-induced VT/VF had a sensitivity of 37.5%, specificity of 88%, positive predictive value of 43% and negative predictive value of 85% for occurrence of death during follow up. An occurrence of secondary composite endpoint consisting of VT/VF recurrence or death was also most frequent in NIPS-inducible group (75% vs 24%, p = 0.037). In a multivariate Cox-Proportional Hazard model induction of VT/VF at NIPS along with age≥65, and treatment with amiodarone was an independent predictor of the composite endpoint during follow-up Conclusions Inducibility of VF/VF during NIPS in patients with primary prevention ICD is associated with higher mortality and higher incidence of composite endpoint consisting of  death or VT/VF during a long term observation. Abstract Figure. Kaplan-Meier survival curves

scholarly journals Evaluation of ventricular tachycardia inducibility after implementation of a standardized programmed ventricular stimulation protocol in patients with repaired Tetralogy of Fallot

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L Herrador Galindo ◽  
J Francisco Pascual ◽  
A Santos Ortega ◽  
J Perez Rodon ◽  
B Benito ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ventricular Tachycardia ◽  
Sudden Cardiac Death ◽  
Tetralogy Of Fallot ◽  
Cardiac Death ◽  
Clinical Information ◽  
Icd Implantation ◽  
Repaired Tetralogy Of Fallot ◽  
Drive Trains

Abstract Introduction The electrophysiologic (EP) evaluation with programmed electrical stimulation (PVS) is generally recommended in patients with repaired Tetralogy of Fallot and additional risk factors for sudden cardiac death. Nevertheless, different PVS protocols have been described. The aim of our study was to evaluate the differences in ventricular tachycardia (VT) inducibility of patients with TOF after the implementation of a standard PVS protocol in the EP laboratory of a Congenital Heart Disease reference center. Methods All patients with repaired TOF who underwent an EP study with PVS between January 2001 and October 2020 were included. The new standardized PVS protocol was performed in 2 ventricular sites (apex and outflow tract) with 3 drive trains (cycle lengths 400, 500 and 600ms) and up to 3 extrastimuli. In absence of VT induction, the protocol was repeated under isoprenaline infusion. This new protocol was implemented since January 2012. Non protocolized PVS studies before 2012 were defined as “Non-standardized”. Baseline clinical information about symptoms and previous arrhythmias was recorded as well as electrocardiogram, echocardiogram and cardiac MRI parameters. Finally, the follow-up events (ICD implantation, sudden cardiac death, global mortality, arrythmias and ICD therapies) were also retrospective recorded. Results A total of 154 EP studies with PVS were performed in 128 patients with repaired TOF. 31 of them were performed before the 1st January 2012 (non-standardized PVS) and 112 were performed with the new standardized protocol. The median follow-up was 6,5 years. Both groups had similar baseline characteristics except LVEF and RVEF, that were lower in the “Non-standardized PVS” group. There were no differences between the ventricular tachycardia inducibility of both protocols (22,3% vs 33,3%; p=0,162). The risk factors for VT inducibility were the QRS length (184,46ms vs 169,34 ms; p=0,038), the RVEF (36,25% vs 43,79; p=0,0007), the presence of ventricular ectopia (VE) (38,5% vs 20,0%; p=0,024) and previous VT (35,9% vs 13,9%; p=0,003). VT induction during EP study was related with ICD implantation (71,8% vs 21,7%, p≤0,001), VT (30,8% vs 20%, p&lt;0,001) and all kind of arrythmias (VT, non-sustained VT, VE and auricular flutter) (41% vs 21,7%, p=0,005) during follow-up. A total of 6 deaths (1 in the group with induced VT and 5 in the group with non-induced VT) were recorded. Conclusions The implementation of a standardized and more complete PVS protocol in patients with repaired TOF has not shown differences in the experience of our center. The risk factors for VT inducibility were the QRS length, the RVEF, the presence of ventricular ectopia and previous VT, which have also been reported as risk factors for sudden cardiac death in previous studies. The presence of VT induction entailed more ICD implantation and more arrythmias at follow-up. FUNDunding Acknowledgement Type of funding sources: None.

Abstract 14575: Implantable Cardiac Defibrillator in the Setting of Tetralogy of Fallot: Long-Term Follow-Up of a French National Multicenter Retrospective Registry

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Abdeslam Bouzeman ◽  
Maxime De Guillebon ◽  
Guillaume Duthoit ◽  
Magalie Ladouceur ◽  
Raphael Martins ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ventricular Tachycardia ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Tetralogy Of Fallot ◽  
Primary And Secondary Prevention ◽  
Long Term Follow Up ◽  
Appropriate Therapy

Background: Tetralogy of Fallot (TOF) is the most frequent form of congenital heart disease managed by EP physicians for potential ICD. However, few studies have reported long-term outcomes of TOF patients with ICD. Methods: Between 2005 and 2014, all TOF patients with ICD in 17 French centers were enrolled in a specific evaluation aiming to determine characteristics at implantation as well as outcomes (overall mortality, appropriate ICD therapies, and device-related complications). Results: Overall 78 patients (45±13 years, 64% males) were enrolled. A majority of patients were implanted in the setting of secondary prevention (73%), whereas the remaining (27%) in primary prevention. Among the latest group, known risk factors for sudden cardiac death were: severe pulmonary regurgitation (30%,) prior palliative shunt (50%), syncope with unknown origin (25%), inducible ventricular tachycardia (45%), QRS duration ≥180ms (18%), non-sustained ventricular tachycardia (25%), and documented sustained supra ventricular tachycardia (45%).Overall, patients implanted in the setting of primary prevention presented with a mean of 3.1±1.4 risk factors. After a mean follow-up of 4.9±3.8 years, 35 patients (45%) experienced at least one appropriate therapy (25% in the primary prevention group compared to 53% in the secondary prevention group), giving annual-incidences of 6.9% (95%CI 0.14-13.7) and 21.3% (12.4-30.3) respectively (P=0,01). The mean time between ICD implantation and the first appropriate therapy was 2.2±3.2 years, without significant differences between primary and secondary prevention. Overall, ≥one ICD-related complication occurred in 30 patients (38%), including inappropriate shock (n=9), major pocket hematoma (n=1), lead dysfunction (n=12), infection (n=4), shoulder algodystrophia (n=2), device failure or dislodgement needing reintervention (n=2). Eventually, four patients were transplanted (5%), and six patients (8%) died during the course of follow-up. Conclusions: Considering relatively long-term follow-up, patients with TOF and ICDs experience high rates of appropriate ICD therapies, in both primary and secondary prevention. Major ICD-related complications remain, however, high.

Ventricular tachycardia and sudden cardiac death might complicate the long-term outcome by patients after tetralogy of Fallot repair

2008 ◽  
Vol 149 (23) ◽  
pp. 1067-1069
Author(s):  
Attila Mihálcz ◽  
Csaba Földesi ◽  
Tamás Szili-Török
Keyword(s):  
Ventricular Tachycardia ◽  
Sudden Cardiac Death ◽  
Tetralogy Of Fallot ◽  
Cardiac Death ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Cardioverter Defibrillator ◽  
Tetralogy Of Fallot Repair

A Fallot-tetralógia miatti műtétet követően a hosszú távú túlélést befolyásoló tényezők közé tartozik a kamrai tachycardia és a hirtelen szívhalál. E betegek gondozásában érdemi segítséget jelent az implantálható cardioverter defibrillátor rendszer. A végleges pacemaker és/vagy implantálható cardioverter defibrillátor implantációját követően ritka, ám potenciálisan letális kimenetelű fertőzéses szövődmény az endocarditis. Ez esetben a leghatékonyabb kezelési mód a kombinált terápia, amely a beültetett készülék + elektródák teljes körű eltávolításából és agresszív antibiotikus kezelésből áll. Célkitűzés: Ilyen esetekben a tervezett reimplantáció különös óvatosságot igényel a nagyobb recidívaarány miatt, amelynek rizikója fokozottabb pacemakerdependencia esetén. Célunk olyan módszer alkalmazása volt, amelynek segítségével a recidíva kockázata minimálisra csökkenthető. Módszer: Esetünkben a korábban Fallot-tetralógia miatt többször műtött, pacemaker-, majd implantálható cardioverter defibrillátor beültetéseken átesett betegnél recidív endocarditis miatt készülék- és elektródaeltávolítást végeztünk, standard antibiotikus terápia alkalmazásával. A reimplantációt minithoracotomián keresztül végeztük. Az így elhelyezett sokkelektróda elégtelen működése miatt egy másik sokkelektródát szubkután vezettünk a hátsó mellkasfali régióba; rendszerünk az indukált kamrafibrillációt sikerrel szüntette meg. Megbeszélés: Esetismertetésünk demonstrálja a szubkután defibrillátorrendszer alkalmazhatóságát és előnyeit speciális körülmények fennállásakor. Felhívjuk a figyelmet arra a tényre, hogy ezt a technikát gyakrabban is lehetne alkalmazni olyan esetekben, amelyekben a transzvénás implantáció nem optimális.

Ventricular tachycardia underdetection by an ICD. When and how to change the wavelet default settings?

2017 ◽  
Vol 4 (45) ◽  
pp. 26-29
Author(s):  
Sławomir Tłuczek ◽  
Janusz Romanek ◽  
Andrzej Przybylski
Keyword(s):  
Heart Failure ◽  
Ventricular Tachycardia ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Wavelet Function ◽  
Supraventricular Arrhythmias ◽  
Detection Zone ◽  
Cardioverter Defibrillator

A 69-year-old patient with a single chamber cardioverter defibrillator (ICD) implanted in primary prevention of sudden cardiac death (heart failure in dilated cardiomyopathy) was admitted to the hospital due to ventricular tachycardia (VT) not recognized by the ICD. After control of ICD, it was concluded that the cause of the absence of ICD intervention was the classification of arrhythmia by Wavelet as a supraventricular. Default settings have been used since the implant – (Wavelet – 70%, Onset and Stability off). The arrhythmia was within the VT detection zone. There were two possible solutions: turning Wavelet off or reducing its threshold. However, considering the absence of supraventricular arrhythmias, the Wavelet function was disabled.

Abstract 10947: Longer and Faster Non-sustained Ventricular Tachycardia in Hypertrophic Cardiomyopathy Patients Predicts for Implantable Cardioverter Defibrillator Shocks and Sudden Cardiac Death

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Weijia Wang ◽  
Zhesi Lian ◽  
Ethan Rowin ◽  
Martin Maron ◽  
Mark Link
Keyword(s):  
Ventricular Tachycardia ◽  
Hypertrophic Cardiomyopathy ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Death ◽  
Medical Center ◽  
Multivariable Analysis ◽  
Sustained Ventricular Tachycardia ◽  
Cardioverter Defibrillator

Introduction: Non-sustained ventricular tachycardia (NSVT) may be underestimated in patients with hypertrophic cardiomyopathy (HCM). Its impact on the risk of sudden cardiac death (SCD) in HCM is controversial. There is no distinction made in the guidelines as to the length or rate of NSVT as a risk marker for SCD. Hypothesis: NSVT may be nearly universal in HCM patients with high risk of SCD and not found because of the limited time frame of monitoring. NSVT may be associated with appropriate Implantable Cardioverter Defibrillator (ICD) shocks and SCD. Methods: A retrospective study of 181 HCM patients who had an ICD and were followed for at least 6 months from 2000 to 2013 at Tufts Medical Center was performed. The pre-operative evaluations as well as routine ICD follow up notes were reviewed. Results: ICD was implanted in 175 (96.7%) patients as primary prevention and in 6 (3.3%) patients as secondary prevention for SCD. Ninety six (53.0%) patients total had NSVT, including 48 (26.5%) before and 77 (42.5%) after ICD implantation. The agreement for detecting NSVT between Holter monitoring and ICD interrogation was poor (Kappa=0.18, p=0.054). Eighteen (18.75%) patients with NSVT and 6 (7.06%) patients without NSVT had appropriate ICD shocks or SCD (Figure 1). In multivariable analysis, NSVT was independently associated with appropriate ICD shocks and SCD (OR 3.69, 95%CI: 1.31 - 10.43) and remained significant in the 175 patients who had ICD implanted as primary prevention (OR 3.86, 95%CI: 1.13 - 13.18). More rapid NSVT (Cl < 310ms) predicted appropriate ICD shocks and SCD (OR 7.7, 95%CI: 1.6, 36.8), and longer NSVT (> 18beats) also predicted appropriate ICD shocks and SCD (OR=23.7, 95%CI: 2.7, 204.9). Conclusion: The agreement for detecting NSVT between Holter and ICD interrogation is poor. NSVT is significantly associated with appropriate ICD shocks and SCD. Faster and longer NSVT are even more predictive. Extending rhythm monitor time merits consideration in HCM patients.

P1462Incidence of ventricular arrhythmias in cardiac resynchronization therapy and implantable cardioverter-defibrillator patients

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Roubicek ◽  
J Morava ◽  
J Stros ◽  
P Kucera ◽  
R Polasek
Keyword(s):  
Heart Failure ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Secondary Prevention ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Death ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Cardioverter Defibrillator

Abstract Introduction Implantation of a cardiac resynchronization therapy combined with cardioverter-defibrillator (CRT-D) is now common practice. Our study looked at the occurrence of the first adequate CRT-D therapy with respect to gender, treatment indication (primary or secondary prevention of sudden cardiac death) and the etiology of heart failure in long-term follow-up. Methods In the database of CRT-D patients implanted between 2005 and 2013 we analyzed the occurrence of treated episodes of ventricular arrhythmia (first shock or anti-tachycardic pacing). Results 250 patients (22.8% females) with left bundle branch block or non-specific interventricular conduction delay were enrolled. 80% of patients were implanted in the primary and 20% in the secondary prevention of sudden cardiac death. During the follow-up of 5.5 ± 2.5 years, 46.4% of patients died for cardiac (25.6%) or non-cardiac (20.8%) reasons. CRT-D therapy occurred in 33.2% of patients (20.8% shock). In patients implanted in the primary prevention of sudden cardiac death the incidence of therapies was 25.5% vs. 64.0% in patients implanted in the secondary prevention of sudden cardiac death (P˂0.00001). The incidence of therapies between the group of patients with coronary artery disease and other causes of heart failure did not differ (33.3% vs. 32.9%, P = NS). Women were at a significantly lower risk of adequate shock (women 10.5% vs. men 23.8%, P = 0.01). Conclusion Adequate CRT-D therapy occurred in a quarter of patients implanted in the primary prevention of sudden cardiac death. In patients implanted in the secondary prevention of sudden cardiac death the incidence of therapies is significantly more frequent. The female gender predicts significantly lower incidence of adequate shock. Abstract Figure. Adequate shock therapy

Long-term Clinical Follow-up of Japanese Heart Failure Patients Received ICD Therapy for Primary Prevention of Sudden Cardiac Death

2008 ◽  
Vol 14 (7) ◽  
pp. S140-S141
Author(s):  
Kenji Ando ◽  
Yoshimitsu Soga ◽  
Masahiko Goya ◽  
Shinichi Shirai ◽  
Shinya Nagayama ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Icd Therapy ◽  
Heart Failure Patients
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