Abstract 3355: Relationship Between Electrocardiographic Remodeling, Mechanical Remodeling and the Occurrence of Appropriate Therapy in Biventricular Implantable Cardioverter Defibrillator Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Nicolas Lellouche ◽  
Carlos De Diego ◽  
Gina Akopyan ◽  
David A Cesario ◽  
Osamu Fujimura ◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Qt Dispersion ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Reverse Remodeling ◽  
Icd Therapy ◽  
Cardioverter Defibrillator ◽  
Reverse Remodelling ◽  
Mechanical Remodeling

Background: Cardiac Resynchronization Therapy (CRT) is associated with reverse left ventricular (LV) remodeling. However, the effect of CRT on electrical remodeling, reverse mechanical remodeling, occurrence of ventricular arrhythmias is not well established. Methods: D ata from 45 patients who underwent implantable cardioverter defibrillator(ICD)-CRT implantation was retrospectively analyzed. Patients had New York Heart Association (NYHA) functional class III or IV heart failure symptoms, left ventricular ejection fraction (LVEF) <35%, and QRS duration >130 ms or QRS ≤130ms with left intraventricular dyssynchrony. Significant LV reverse remodeling was defined by a decrease of left ventricular end diastolic diameter (LVEDd) by at least 10% after 1 year of follow up. Electrocardiographic indices of dispersion of repolarization (DR) (QTc, T peak-Tend (Tp-e) and their dispersion) were measured immediately and 1 year after implantation. The occurrence of appropriate ICD therapy was noted for each patient. Results: Patients with significant LV reverse remodeling (n=21) and without LV reverse remodeling (n=24) had similar baseline characteristics. After one year of follow up, patients with LV reverse remodeling exhibited a significant decrease in DR parameters (Tp-e, QT dispersion and Tp-e dispersion), and lower rate of appropriate ICD therapy (log rank p=0.002), compared to those without reverse remodeling who experienced an increase in DR parameters (QT dispersion and Tp-e dispersion), figure 1 . Conclusion: Mechanical LV reverse remodeling is associated with an electrical reverse remodelling and a lower rate of appropriate ICD therapy. Figure 1: Occurence of appropriate CD therapy according to LV reverse remodelling

Abstract 13843: Icd Therapy After the First Primary-Prevention Implantable Cardioverter-Defibrillator Battery Change-out

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Benjamin H Buck ◽  
Eric Kellett ◽  
Rana Elgazzar ◽  
Chad Ward ◽  
Omar Kahaly ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Implantable Cardioverter Defibrillator ◽  
Care Center ◽  
Therapeutic Benefit ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Free Survival ◽  
Icd Therapy ◽  
Cardioverter Defibrillator

Background: Implantable cardioverter-defibrillator (ICD) therapy prevents sudden cardiac death in selected patients with heart failure. When a primary prevention ICD arrives at elective replacement interval (ERI), conventional management is to replace the device. However, the effectiveness of ICDs in patients with nonischemic and ischemic cardiomyopathy (NICM and ICM, respectively) whose left ventricular ejection fraction (LVEF) improved to ≥50% before replacement is unclear. Hypothesis: The therapeutic benefit of primary prevention ICD for NICM is attenuated by the recovery of LVEF at the time of ERI. Methods: Consecutive patients presenting for first time primary prevention ICD battery change-out at a single quaternary care center between 1/1/2008 and 6/27/2019 were included. The primary endpoint was the rate of ICD therapy (ICD discharge and anti-tachycardia pacing) according to LVEF recovery at ERI. Results: During the study period 6851 ICDs were placed, of which 310 underwent battery change-out, of whom 100 did not receive therapy from the first ICD, of whom 44 had NICM. The demographics of the NICM cohort are in the table. Following ERI, 0 (0%) with NICM and recovered LVEF had received ICD therapy, whereas 13 (30%) with persistently low LVEF had received therapy (p = 0.07). Furthermore, among patients without recovered LVEF, the NICM group had a lower rate of therapy (4, 12%) than the ICM group (12, 32%) (p=0.04). Conclusion: Rates of ICD therapy provided by primary prevention ICD after first battery change out trended towards a significantly lower rate in NICM patients with LVEF that recovered to ≥50% than those without LVEF recovery. No other patient demographic significantly predicted therapy-free survival but the analysis was limited by sample size. A prospective study with a larger cohort would be necessary to better estimate therapy-free survival.

scholarly journals Impact of Myocardial Bridge on Life‐Threatening Ventricular Arrhythmia in Patients With Implantable Cardioverter Defibrillator

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Kozo Okada ◽  
Kiyoshi Hibi ◽  
Yutaka Ogino ◽  
Nobuhiko Maejima ◽  
Shinnosuke Kikuchi ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Ventricular Arrhythmia ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Myocardial Bridge ◽  
Cardioverter Defibrillator ◽  
Life Threatening

Background Myocardial bridge (MB), common anatomic variant, is generally considered benign, while previous studies have shown associations between MB and various cardiovascular pathologies. This study aimed to investigate for the first time possible impact of MB on long‐term outcomes in patients with implantable cardioverter defibrillator, focusing on life‐threatening ventricular arrhythmia (LTVA). Methods and Results This retrospective analysis included 140 patients with implantable cardioverter defibrillator implantation for primary (n=23) or secondary (n=117) prevention of sudden cardiac death. Angiographically apparent MB was identified on coronary angiography as systolic milking appearance with significant arterial compression. The primary end point was the first episode(s) of LTVA defined as appropriate implantable cardioverter defibrillator treatments (antitachyarrhythmia pacing and/or shock) or sudden cardiac death, assessed for a median of 4.5 (2.2–7.1) years. During the follow‐up period, LTVA occurred in 37.9% of patients. Angiographically apparent MB was present in 22.1% of patients; this group showed younger age, lower rates of coronary risk factors and ischemic cardiomyopathy, higher prevalence of vasospastic angina and greater left ventricular ejection fraction compared with those without. Despite its lower risk profiles above, Kaplan–Meier analysis revealed significantly lower event‐free rates in patients with versus without angiographically apparent MB. In multivariate analysis, presence of angiographically apparent MB was independently associated with LTVA (hazard ratio, 4.24; 95% CI, 2.39–7.55; P <0.0001). Conclusions Angiographically apparent MB was the independent determinant of LTVA in patients with implantable cardioverter defibrillator. Although further studies will need to confirm our findings, assessment of MB appears to enhance identification of high‐risk patients who may benefit from closer follow‐up and targeted therapies.

scholarly journals 435 Left ventricular reverse remodeling and angiotensin ii receptor blocker neprilysin inhibitor - a real-world data

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Martinho ◽  
J Almeida ◽  
A Freitas ◽  
C Ferreira ◽  
F Franco ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Reverse Remodeling ◽  
Angiotensin Ii Receptor Blocker ◽  
Target Dose ◽  
Left Ventricular Reverse Remodeling ◽  
Reverse Remodelling

Abstract BACKGROUND Although sacubitril/valsartan (ARNI) improves the NYHA functional class and prognosis in patients with heart failure with reduced ejection fraction (HFrEF), its impact on reverse remodelling is uncertain. We assessed left ventricular reverse remodeling in a cohort of HFrEF patients treated with ARNI. METHODS We conducted a single-centre, retrospective, observational study of 200 HFrEF patients started on ARNI during 2018. Of these, we analysed 100 patients treated with the maximum, target dose (97/103 mg bid). Baseline clinical, laboratory and demographic characteristics were evaluated and a clinical and echocardiographic follow-up, including left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (GLS), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV) and mitral valve regurgitation (MR), were conducted from ARNI initiation to a 3-month landmark. RESULTS Mean age was 59 ± 13 years and 85% were male. At baseline, 63% were on NYHA II, 34% in NYHA III and 3% in NYHA IV functional class. Mean systolic blood pressure was 125 ± 16 mmHg, median NT-proBNP was 773 pg/dL (IQR 386-1569) and mean LVEF 27 ± 7%. Median time between initiation of the drug and reaching the target dose was 10 weeks. Functional class significantly improved; at baseline, 37% of patients were in NYHA III-IV; 3 months after target dose, only 6% remained in NYHA III-IV (p = 0.005). Half of patients (48.6%) improved LVEF (from 27 ± 7% to 31 ± 10%, mean increase 4.2 ± 8.8%; 95%CI 2.1 to 6.3, p &lt; 0.001) and in one quarter (24.6%) LVEF improved over 35% (p &lt; 0.001). In a echocardiographic subgroup analysis, including a random sample of 35 patients, we found a significant improvement in GLS 1.5 ± 2.9 (95%CI 0.4 to 2.6%, p = 0.009), a significant decrease in LVESV and LVEDV 29 ± 3 mL (95%CI -42.6mL to -15.4mL, p &lt; 0.001) and 31 ± 47ml (95% CI -48 to -15, p &lt; 0.001), respectively, and a significant improvement in MR severity (p = 0.001). CONCLUSIONS We observed that in an HFrEF patient population treated with ARNI there was a significant clinical improvement, who may be explained by a robust impact on reverse remodelling, even on a short-time of follow-up. An interesting finding was that 24.6% improved LVEF above the 35% cut-off, and therefore lost an indication for a prophylactic implantable cardioverter defibrillator.

Controversies in Implantable Cardioverter-defibrillator Therapy

2011 ◽  
Vol 7 (3) ◽  
pp. 199
Author(s):  
Alessandro Marinelli ◽  
Mario Luzi ◽  
Alessandro Capucci ◽  
◽  
◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Optimal Time ◽  
Icd Implantation ◽  
Ventricular Ejection Fraction ◽  
Icd Therapy ◽  
Cardioverter Defibrillator ◽  
Future Events ◽  
Relative Rarity

Implantable cardioverter-defibrillator (ICD) therapy is a mainstay in sudden cardiac death (SCD) prevention. Its efficacy has been proven in several conditions such as heart failure and reduced left ventricular ejection fraction (LVEF) and in familial SCD syndromes. In contrast to the fairly clear role of ICD therapy for secondary prevention, its role and indications for primary prevention of SCD has been more difficult to define. Many questions remain unresolved in this setting, such as the choice of the optimal time for implantation after a myocardial infarction and the degree of LVEF reduction that is able to predict future events and to justify the risks of ICD implant. The choice of ICD therapy may also be challenging in patients with different demographic features and comorbidities from that enrolled in clinical trials. Finally, the relative rarity of familial SCD syndromes seriously limits the data upon which recommendations are based and therefore many questions concerning the risk-benefit of ICD implantation remain unresolved.

Incidence of appropriate implantable cardioverter-defibrillator therapy and mortality after implantable cardioverter-defibrillator generator replacement: results from a real-world nationwide cohort

EP Europace ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. 1211-1219 ◽  
Author(s):  
Martin H Ruwald ◽  
Anne-Christine Ruwald ◽  
Jens Brock Johansen ◽  
Gunnar Gislason ◽  
Jens Cosedis Nielsen ◽  
...  
Keyword(s):  
Implantable Cardioverter Defibrillator ◽  
Left Ventricular ◽  
Advanced Age ◽  
Left Ventricular Ejection ◽  
Icd Therapy ◽  
Cardioverter Defibrillator ◽  
Risk Of Death ◽  
Comorbidity Burden ◽  
Appropriate Therapy ◽  
Generator Replacement

Abstract Aims The safety of omitting implantable cardioverter-defibrillator (ICD) generator replacement in patients with no prior appropriate therapy, comorbid conditions, and advanced age is unclear. The aim was to investigate incidence of appropriate ICD therapy after generator replacement. Methods and results We identified patients implanted with a primary prevention ICD (n = 4630) from 2007 to 2016, who subsequently underwent an elective ICD generator replacement (n = 670) from the Danish Pacemaker and ICD Register. The data were linked to other databases and evaluated the outcomes of appropriate therapy and death. Predictors of ICD therapy were identified using multivariate Cox regression analyses. A total of 670 patients underwent elective ICD generator replacement. Of these, 197 (29.4%) patients had experienced appropriate therapy in their 1st generator period. During follow-up of 2.0 ± 1.6 years, 95 (14.2%) patients experienced appropriate therapy. Predictors of appropriate therapy in 2nd generator period was low initial left ventricular ejection fraction (≤25%) [hazard ratio (HR) 1.87, confidence interval (CI) 1.13–1.95] and appropriate therapy in 1st generator period (HR 3.95, CI 2.57–6.06). For patients with appropriate therapy in 1st generator period, 4-year incidence of appropriate therapy was 50.6% vs. 16.4% in those without (P < 0.001). Among patients >80 years with no prior appropriate therapy 8.8% of patients experienced appropriate therapy after replacement. Comorbidity burden and advanced age were associated with reduced device utilization after replacement and a high competing risk of death without preceding appropriate therapy. Conclusion A significant residual risk of appropriate therapy in the 2nd generator was present even among patients with advanced age and with a full prior generator period without any appropriate ICD events.

scholarly journals Long-term outcomes among a cohort of 4296 implantable cardioverter-defibrillator patients: insights from the UMBRELLA study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Briongos Figuero ◽  
A Garcia Alberola ◽  
J Rubio ◽  
J M Segura ◽  
A Rodriguez ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Heart Disease ◽  
Implantable Cardioverter Defibrillator ◽  
Remote Monitoring ◽  
Lower Risk ◽  
Left Ventricular ◽  
Icd Therapy ◽  
Cardioverter Defibrillator

Abstract Background Large observational real-world studies describing modern implantable cardioverter-defibrillator (ICD) populations with long-term follow-up are lacking. Purpose To assess the incidence of arrhythmias in a cohort of contemporary patients undergoing ICD implant from 2005 and 2017 and to analyze the arrhythmic risk and mortality according to their clinical profiles. Methods UMBRELLA (NTC01561144) is a prospective, multicentre, nationwide study of ICD patients followed by remote monitoring. All device information was automatically stored through the remote monitoring system and a blinded review of all the stored arrhythmic episodes was performed. The study outcomes were first appropriate ICD therapy and all-cause death. Results The study population consisted of 4296 patients (61.9±12.9 years, ischaemic cardiomyopathy (ICM): n=2150, dilated cardiomyopathy (DCM): n=1166, valvular heart disease (VHD): n=119, hypertrophic cardiomyopathy (HCM): n=294, arrhythmogenic right ventricular cardiomyopathy (ARVC): n=71, Brugada syndrome (BS): n=143, long QT syndrome (LQTS): n=43, and adult congenital heart disease (ACHD): n=60)). Primary prevention (PP) was the main indication (n=2758). During a mean follow-up of 46.6±27.3 months, 16,067 episodes of sustained ventricular arrhythmia (SVA) occurred in 1344 patients. Appropriate ICD therapy was delivered to 85.7% (n=13,767) episodes of SVA in 1173 patients (27.3% of population). A higher risk of first appropriate ICD therapy was observed in VHD (HR: 1.94, 95% CI: 1.43–2.62), ARVC (HR: 1.84, 95% CI: 1.28–2.66), ICM (HR: 1.51, 95% CI: 1.29–1.78), and DCM (HR: 1.28, 95% CI: 1.07–1.53) whereas patients with HCM (HR: 0.72, 95% CI: 0.54–0.96) and BS (HR: 0.25, 95% CI: 0.14–0.45) were at significantly lower risk (Figure 1A). In multivariate analysis (Table 1), age, gender, atrial fibrillation (AF), secondary prevention, LVEF ≤35%, and QRS width emerged as clinical predictors of appropriate ICD therapy, whereas CRT-D correlated with lower risk. An independently higher risk was found in DCM, VHD, and ARVC, and a lower risk in BS patients. At follow-up, 590 deaths (13.4% of population) were reported. Patients with ICM (HR 3.90, 95% CI: 2.58–5.90), DCM (HR 3.33, CI 95%: 2.18–5.10), and VHD (HR 3.97, CI 95%: 2.25–6.99) had worse prognoses and it was significantly better in BS patients (HR 0.11, 95% CI: 0.01–0.67, p=0.017) (Figure 1B). In multivariate analysis, age, gender, AF, renal failure, diabetes and reduced LVEF, emerged as independent predictors of all-cause death (Table 1). Conclusions Irrespective of the aetiology, contemporary ICD patients with an arrhythmic substrate derived from left ventricular systolic dysfunction had a similar risk of ICD life-saving interventions and death. FUNDunding Acknowledgement Type of funding sources: None. Table 1 Figure 1

scholarly journals CMR-Based Risk Stratification of Sudden Cardiac Death and Use of Implantable Cardioverter–Defibrillator in Non-Ischemic Cardiomyopathy

2021 ◽  
Vol 22 (13) ◽  
pp. 7115
Author(s):  
Laura Keil ◽  
Céleste Chevalier ◽  
Paulus Kirchhof ◽  
Stefan Blankenberg ◽  
Gunnar Lund ◽  
...  
Keyword(s):  
Sudden Cardiac Death ◽  
Risk Stratification ◽  
Implantable Cardioverter Defibrillator ◽  
Cardiac Death ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Icd Implantation ◽  
Icd Therapy ◽  
Cardioverter Defibrillator

Non-ischemic cardiomyopathy (NICM) is one of the most important entities for arrhythmias and sudden cardiac death (SCD). Previous studies suggest a lower benefit of implantable cardioverter–defibrillator (ICD) therapy in patients with NICM as compared to ischemic cardiomyopathy (ICM). Nevertheless, current guidelines do not differentiate between the two subgroups in recommending ICD implantation. Hence, risk stratification is required to determine the subgroup of patients with NICM who will likely benefit from ICD therapy. Various predictors have been proposed, among others genetic mutations, left-ventricular ejection fraction (LVEF), left-ventricular end-diastolic volume (LVEDD), and T-wave alternans (TWA). In addition to these parameters, cardiovascular magnetic resonance imaging (CMR) has the potential to further improve risk stratification. CMR allows the comprehensive analysis of cardiac function and myocardial tissue composition. A range of CMR parameters have been associated with SCD. Applicable examples include late gadolinium enhancement (LGE), T1 relaxation times, and myocardial strain. This review evaluates the epidemiological aspects of SCD in NICM, the role of CMR for risk stratification, and resulting indications for ICD implantation.

scholarly journals Implantable cardioverter-defibrillator oversensing due to electric shock

2010 ◽  
Vol 138 (3-4) ◽  
pp. 236-239
Author(s):  
Ruzica Jurcevic ◽  
Lazar Angelkov ◽  
Dejan Vukajlovic ◽  
Velibor Ristic ◽  
Milosav Tomovic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Sinus Rhythm ◽  
Implantable Cardioverter Defibrillator ◽  
Electric Shock ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Circumflex Artery ◽  
Ventricular Ejection Fraction ◽  
Cardioverter Defibrillator ◽  
First Case

Introduction. We described the first case of oversensing due to electric shock in Serbia, in a 54-year-old man who had implantable cardioverter-defibrillator (ICD). Case Outline. In July 2002, the patient had acute anteroseptal myocardial infarction and ventricular fibrillation (VF) which was terminated with six defibrillation shocks of 360 J. Coronary angiography revealed 30% stenosis of circumflex artery, the left anterior descending coronary artery was recanalized and the right coronary artery was without stenosis. Left ventricular ejection fraction was 20%. In December 2003, an electrophysiology study was performed and ventricular tachycardia (VT) was induced and terminated with 200 J defibrillation shock. Single chamber ICD Medtronic Gem III VR was implanted in January 2004 and defibrillation threshold was 12 J. The patient was followed up during three years every three months and there were no VT/VF episodes and VT/VF therapies. In December 2007, the patient experienced electric shock through the fork while he was making barbecue on the electric grill. ICD recognized this event in VF zone (oversensing) and delivered defibrillation shock of 18 J. The electrogram of the episode showed ventricular sensing - intrinsic sinus rhythm with electric shock potentials which were misidentified as VF. After charge time of 3.16 seconds, ICD delivered defibrillation shock and sinus rhythm was still present. Conclusion. Oversensing of ICD has different aetiology and the most common cause is supraventricular tachyarrhythmia.

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