P876Ventricular tachycardia detected by remote monitoring of implantable cardioverter-defibrillator patients is associated with increased risk of ICD shock therapy

Purpose: Implantable Cardioverter Defibrillator (ICD) prevents sudden cardiac death in high risk patients with heart failure (HF). Worsening renal function (WRF) is associated with mortality in patients with myocardial infarction or HF, but its effect on lethal arrhythmia is unknown. We evaluated the influence of WRF on the occurrence of arrhythmic events in patients with nonischemic HF and ICD. Methods: A total of 286 nonischemic HF patients who underwent ICD implantation between 1990 and 2007 were studied. Estimated Glomerular Filtration Rate (eGFR) was calculated using the Modification of Diet in Renal Disease. Renal dysfunction was defined as eGFR <60mL/min/1.73m 2 and WRF was defined as 15mL/min/1.73m 2 per year. Differences in arrhythmia recurrences according to the eGFR and WRF were compared by Kaplan-Meier survival curves. Results: During a mean follow-up time of 2.2+/−1.0 years, 94 (33%) of 286 patients (mean age; 57+/−15 years, 72% male) experienced appropriate ICD shock therapy. There was a significantly higher cumulative rate of appropriate ICD shock therapy (p<0.05) and electrical storm (p<0.05) in patients with renal dysfunction than others. The patients with renal dysfunction at baseline experience WRF more frequently than other patients (53% vs. 23%, respectively, p<0.01). After correcting for age, sex, left ventricular ejection fraction (LVEF), indication for ICD implantation, and use of beta-blockers in a Cox regression model, WRF was still an independent predictor of the time to first appropriate shock (HR 2.21, 95% CI 1.32–3.69, p<0.05) and electrical storm (HR 2.22, 95% CI 1.19 – 4.13, p<0.05). The result of subgroup analysis of 147 patients with low LVEF (LVEF<35%) indicated that the patients with WRF experienced electrical storms more frequently (p<0.05). Conclusion: WRF is associated with increased rate of arrhythmic event in nonischemic HF patients. Especially, those patients with low LVEF and WRF experience more frequent ICD shocks.

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Abstract 2037: Renal Dysfunction and Appropriate Shock Therapy in Implantable Cardioverter Defibrillator Patients with Nonischemic Heart Failure

Circulation ◽

10.1161/circ.116.suppl_16.ii_441-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Atsushi Takahashi ◽

Tsuyoshi Shiga ◽

Keisuke Futagawa ◽

Ryusuke Kimura ◽

Koichiro Ejima ◽

...

Keyword(s):

Heart Failure ◽

Renal Insufficiency ◽

Renal Dysfunction ◽

Implantable Cardioverter Defibrillator ◽

Shock Therapy ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Icd Implantation ◽

Cardioverter Defibrillator ◽

Icd Shock

Background: Implantable Cardioverter Defibrillator (ICD) prevent sudden cardiac death in high risk patients with heart failure. The presence of coexisting conditions has a substantial effect on the rate of arrhythmic events in heart failure patients. Renal dysfunction is associated with mortality in patients with myocardial infarction or heart failure, but the influence of degrees of renal impairment is less well defined. Methods: A total of 221 patients who underwent ICD implantation were included between 1990 and 2006. Gromerular Filteration Rate (GFR) was estimated using the Modification of Diet in Renal Disease (MDRD) and renal insufficiency was defined as MDRD GFR<60mL/min/1.73m 2 . Differences in arrhythmia recurrences according to the MDRD GFR were compared by Kaplan-Meier survival curves. Results: During a mean follow-up time of 3.7±2.8 years, 82 (37%) of 221 patients (mean age; 4.7±1.3 years, 71% male) experienced appropriate ICD shock therapy. There was a trend of higher cumulative rate of appropriate ICD shock therapies in patients with renal insufficiency than other patients (p<0.10). The result of subgroup analysis of 94 patients with low LVEF (LVEF<35%) indicated that the patients with renal insufficiency experienced electrical storms more frequently (p<0.05). After correcting for age, sex, left ventricular ejection fraction (LVEF), indication for ICD implantation, and use of beta-blockers in a Cox regression model, low MDRD GFR was still an independent predictor of the time to first appropriate ICD shock (hazard ratio [HR] 2.30, 95% confidence interval [CI] 1.13–4.69, p<0.05). Below 60mL/min/1.73m 2 , each reduction of the MDRD GFR by 10 units was associated with a HR for appropriate shock of 1.40 (95% CI, 1.00 to 1.95). Conclusion: Renal insufficiency is associated with increased rate of arrhythmic event in nonischemic HF patients. Especially, those patients with low LVEF and renal dysfunction experience more frequent ICD shocks.

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Abstract 12981: Does Volume Overload Predict Failed Antitachycardia Pacing Therapy for Ventricular Tachycardia in Patients With an Implantable Cardioverter-Defibrillator?

Circulation ◽

10.1161/circ.130.suppl_2.12981 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Alireza Hosseini-khalili ◽

Jeffrey Kluger

Keyword(s):

Ventricular Tachycardia ◽

Implantable Cardioverter Defibrillator ◽

Ischemic Cardiomyopathy ◽

Volume Overload ◽

Decompensated Heart Failure ◽

Shock Therapy ◽

Diagnostic Parameter ◽

Antitachycardia Pacing ◽

Cardioverter Defibrillator ◽

Icd Shock

Introduction: Decompensated heart failure (HF) increases the risk of Implantable Cardioverter-Defibrillator (ICD) therapy. Patients with failed antitachycardia pacing (ATP) for ventricular tachycardia (VT) termination, requiring ICD shock, have been reported to have worse outcomes compared to patients with effective ATP. Thoracic impedance (TI) is a diagnostic parameter found in many ICDs. In Medtronic devices, TI is transformed into a OptiVol index, which when elevated, may represent volume overload and can predict increased HF events. Hypothesis: Whether an elevated OptiVol index is associated with failed ATP for VT termination in ICD patients. Method: Retrospective review of a prospectively collected database of patients followed in a dedicated ICD clinic, enrolled in remote ICD monitoring and who received therapy for VT termination by an OptiVol-capable ICD. The level of OptiVol was measured near the time of VT events. VT events were divided into two groups: OptiVol index <100 and OptiVol≥100, and distributions of successful and unsuccessful ATP were compared. Results: We analyzed 121 VT episodes that occurred in 39 ICD patients who received ATP or shock to terminate VT. Mean age of patients was 68.4 +/- 10 years and 32 patients (78%) were male. Ischemic cardiomyopathy was present in 20 patients (48.8%). Successful ATP was more likely when the VT event was associated with an OptiVol index <100 (74.5% successful vs 25.5% unsuccessful, P<0.001); whereas a VT event associated with an OptiVol≥100 was more likely to be unresponsive to ATP compared with ATP success (66.7% unsuccessful vs 33.3% successful, p<0.001). Conclusions: Failed ATP, requiring shock therapy for VT, is associated with a measure of volume overload (OptiVol) and could explain the worse outcomes observed in patients who require ICD shocks.

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Impact of COVID-19 on the incidence of cardiac arrhythmias in implantable cardioverter defibrillator recipients followed by remote monitoring

Archives of Cardiovascular Diseases ◽

10.1016/j.acvd.2021.02.005 ◽

2021 ◽

Author(s):

Vincent Galand ◽

Elliot Hwang ◽

Estelle Gandjbakhch ◽

Frédéric Sebag ◽

Eloi Marijon ◽

...

Keyword(s):

Implantable Cardioverter Defibrillator ◽

Remote Monitoring ◽

Cardiac Arrhythmias ◽

Cardioverter Defibrillator

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P1742Assessment of quality of life and ICD shock-related anxiety in patients with implantable cardioverter defibrillator: the PainFree SST study

EP Europace ◽

10.1093/ehjci/eux161.052 ◽

2017 ◽

Vol 19 (suppl_3) ◽

pp. iii379-iii379

Author(s):

Y. Kondo ◽

S. Sasaki ◽

S. Sears ◽

M. Okamoto ◽

B. Gerritse ◽

...

Keyword(s):

Quality Of Life ◽

Implantable Cardioverter Defibrillator ◽

Cardioverter Defibrillator ◽

Icd Shock

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Sacubitril/valsartan reduces atrial fibrillation and supraventricular arrhythmias in patients with HFrEF and remote monitoring: preliminary data from the SAVE THE RHYTHM

European Heart Journal ◽

10.1093/ehjci/ehaa946.0926 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

F Guerra ◽

L Pimpini ◽

M Flori ◽

D Contadini ◽

G Stronati ◽

...

Keyword(s):

Atrial Fibrillation ◽

Implantable Cardioverter Defibrillator ◽

Remote Monitoring ◽

Preliminary Data ◽

Premature Ventricular Contractions ◽

Cardioverter Defibrillator ◽

Neprilysin Inhibitor ◽

History Of ◽

Secondary Endpoints ◽

The Mean

Abstract Background Sacubitril/valsartan, the first combined angiotensin receptor-neprilysin inhibitor, has demonstrated a significant benefit compared to angiotensin inhibitor in decreasing ventricular arrhythmias and appropriate implantable cardioverter defibrillator (ICD) shocks in patients with heart failure with reduced ejection fraction (HFrEF). At present, there is no study which evaluates the effect of sacubitril/valsartan on the supraventricular arrhythmic burden in HFrEF patients with an ICD or cardiac resynchronisation therapy-defibrillator (CRT-D) and remote monitoring. Purpose To evaluate the effect of sacubitril/valsartan on the supraventricular arrhythmic burden in HFrEF patients with an ICD or CRTD and remote monitoring. Methods The SAVETHERHYTHM ((SAacubitril Valsartan rEal-world registry evaluating THE arRHYTHMia burden in HFrEF patients with implantable cardioverter defibrillator) is a multicentre, observational, prospective registry enrolling all patients with HFrEF, ICD or CRT-D actively followed through remote monitoring and starting treatment with sacubitril/valsartan. All patients are followed-up for at least one year after sacubitril/valsartan start. The primary endpoint is the mean number of sustained atrial tachycardia or atrial fibrillation (AT/AF) episodes per month. Secondary endpoints include the total burden of AT/AF (defined as the percentage of time in AT/AF per day), the mean number of premature ventricular contractions (PVC) per hour and the percentage of biventricular pacing per day (in patients with CRT-D). All primary and secondary endpoints are collected through remote monitoring. Results At the time of the first ad interim analysis, 60 patients (85.2% male, age 69±10 years) were consecutively enrolled. After treatment with sacubitril/valsartan, patients with at least one episode of AT/AF per month decreased from 32.8% to 21.3% (p=0.015). A significant decrease in number of AT/AF episodes (from 4.3 to 1.2 per year), in AT/AF burden (from 12% to 9%) and in number of PVC (from 83 to 74 per hour) were seen in patients with a previous diagnosis of paroxysmal or persistent AF (n=15; all p<0.05). Patients with permanent AF (n=7) experienced no benefits from sacubitril/valsartan therapy in terms of arrhythmic burden reduction. Patients with no previous history of AF (n=38) showed a decrease in number of AT/AF episodes (from 2.0 to 0.8 per year) and in number of PVC (from 77 to 49 per hour, all p<0.05). No new diagnosis of clinical AF was made after starting treatment with sacubitrl/valsartan, and patients with subclinical AT/AF episodes decreased from 8% to 3%. Conclusions Preliminary data suggest that therapy with sacubitril/valsartan could decrease arrhythmic burden in patients with non-permanent AF and reduce subclinical AT/AF episodes in patients with no history of AF. No positive effect has been noted in patients with permanent AF. Funding Acknowledgement Type of funding source: None

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5968Adherence to driving restrictions among patients with an implantable cardioverter defibrillator: insights from a nationwide register-linked survey study

European Heart Journal ◽

10.1093/eurheartj/ehz746.0109 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Bjerre ◽

S M Rosenkranz ◽

M Schou ◽

C Jons ◽

B T Philbert ◽

...

Keyword(s):

Logistic Regression ◽

Primary Prevention ◽

Secondary Prevention ◽

Implantable Cardioverter Defibrillator ◽

Survey Study ◽

Icd Implantation ◽

Cardioverter Defibrillator ◽

Driving Restrictions ◽

Driver's License ◽

Icd Shock

Abstract Background Patients with an implantable cardioverter defibrillator (ICD) are restricted from driving following initial implantation or ICD shock. It is unclear how many patients are aware of, and adhere to, these restrictions. Purpose To investigate knowledge of, and adherence to, private and professional driving restrictions in a nationwide cohort of ICD patients. Methods A questionnaire was distributed to all living Danish residents ≥18 years who received a first-time ICD between 2013 and 2016 (n=3,913). During this period, Danish guidelines recommended 1 week driving restriction following ICD implantation for primary prevention, and 3 months following either ICD implantation for secondary prevention or appropriate ICD shock, and permanent restriction of professional driving and driving of large vehicles (>3.5 metric tons). Questionnaires were linked with relevant nationwide registries. Logistic regression was applied to identify factors associated with non-adherence. Results Of 2,741 questionnaire respondents, 92% (n=2,513) held a valid private driver's license at time of ICD implantation (85% male; 46% primary prevention indication; median age: 67 years (IQR: 59–73)). Of these, 7% (n=175) were actively using a professional driver's license for truck driving (n=73), bus driving (n=45), taxi driving (n=22), large vehicle driving for private use (n=54), or other purposes (n=32) (multiple purposes allowed). Only 42% of primary prevention patients, 63% of secondary prevention patients, and 72% of patients who experienced an appropriate ICD shock, recalled being informed of any driving restrictions. Only 45% of professional drivers recalled being informed about specific professional driving restrictions (Figure). Most patients (93%, n=2,344) resumed private driving after ICD implantation, more than 30% during the driving restriction period: 34% of primary prevention patients resumed driving within 1 week, 43% of secondary prevention patients resumed driving within 3 months, and 30% of patients who experienced an appropriate ICD shock resumed driving within 3 months. Professional driving was resumed by 35%. Patients who resumed driving within the restricted periods were less likely to report having received information about driving restrictions (all p<0.001) (Figure). In a multiple logistic regression model, non-adherence was predicted by reporting non-receipt of information about driving restrictions (OR: 3.34, CI: 2.27–4.03), as well as male sex (OR: 1.53, CI: 1.17–2.01), age ≥60 years (OR: 1.20, CI: 1.02–1.64), receipt of a secondary prevention ICD (OR: 2.2, CI: 1.80–2.62), and being the only driver in the household (OR: 1.29, CI: 1.05–1.57). Conclusion In this nationwide survey study, many ICD patients were unaware of the driving restrictions, and many ICD patients, including professional drivers, resumed driving within the restricted periods. More focus on communicating driving restrictions might improve adherence. Acknowledgement/Funding Danish Heart Foundation, Arvid Nilsson Foundation, Fraenkels Mindefond

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