Abstract 15967: Risk of Ventricular Tachyarrhythmias Following Ejection Fraction Improvement in Patients With Implantable Cardiac Defibrillators Implanted for Primary Prevention of Sudden Cardiac Death

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jayasree Pillarisetti ◽  
Rakesh Gopinathannair ◽  
Matthew Haney ◽  
Madhu Reddy ◽  
Sandeep Reddy ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Ejection Fraction ◽  
Cardiac Death ◽  
High Volume ◽  
Icd Implantation ◽  
Cardiac Device ◽  
Inappropriate Shocks ◽  
Social Security Death Index

Introduction: In patients who undergo cardiac device (ICD) implantation for primary prevention of sudden cardiac death (SCD), data is unclear if their generator needs to be replaced at end of life if their ejection fraction improves. Despite improvement in EF however, the underlying scar may remain the same. Methods: A retrospective study was performed at two high volume centers. Data on 280 patients who underwent ICD implantation for primary prevention of SCD was obtained after excluding patients with incomplete follow-up data. These patients were followed until November 2013 for any improvement in EF and if they underwent a generator change at device ERI. All arrhythmic events and appropriate and inappropriate shocks/ATP were all recorded. Mortality records were obtained from social security death index and chart review. Results: Thirty percent (n=86/280) of patients improved their EF to > 35% of which 41% (n=36) underwent a generator change by the study ending period for ERI/lead malfunction/infection issues with the rest not yet at ERI. Mean baseline EF in patients with and without EF improvement was 26±7% and 23±7%, p=0.2. Data for arrhythmic events was unavailable in n=25 patients in those with EF improvement and n =39 patients in those without EF improvement. Among the remaining 61 patients, appropriate events (shock+ATP) were noted in 22% of patients (n=14/61) and inappropriate shocks and ATP in 6% of (n=4/61) patients after their EF improved to > 35%. Two patients received a prior shock when their EF was low. In contrast, in patients who had no improvement in EF, 31% (n=48/155) received an appropriate event (p=<0.01) while 14% (n=22/155) (p<0.02) received inappropriate shocks and ATP. All-cause mortality in patients without subsequent improvement in EF versus those with EF improvement (38% vs. 17% (p=.006). Mean time to EF improvement was 44±35 months and mean duration of follow-up since EF improvement was 38±27 months. Conclusions: Although patients with improvement in EF had fewer total events (ATP+shock) than those without improvement, the percentage of patients with ICD therapy post EF improvement with no prior ICD discharges is high enough (20%, n=12/59) to warrant an ICD despite EF improvement.

scholarly journals Prevention of sudden cardiac death by the implantable cardioverter-defibrillator in adults with inherited heart disease. long term follow-up

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
M Herruzo Rojas ◽  
A Gomez Lopez ◽  
MA Martin Toro ◽  
PJ Gonzalez Perez ◽  
FJ Morales Ponce
Keyword(s):  
Heart Disease ◽  
Genetic Testing ◽  
Hypertrophic Cardiomyopathy ◽  
Primary Prevention ◽  
High Risk ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Supraventricular Arrhythmias ◽  
Icd Implantation

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Inherited heart diseases include all inheritable channelopathies or cardiomyopathies. Sudden cardiac death (SCD) might be the first and last clinical presentation. ICD implantation  is established as a therapeutic tool according to risk criteria. OBJETIVES The aim of this study is to analyze the population characteristics in ICD/ CRT-ICD recipients in patients with inherited heart disease and establish possible risk predictor factors of arrhytmogenic events during follow-up. MÉTHODS: This is a prospective single-center registry. We included all patients from January1, 2012, to December 31, 2020 who subsequently underwent ICD/ ICD-CRT implantation. RESULTS A total of 172 patients were included with a mean age of 60.47 ± 13,1 years and a mean follow-up duration of 49.71 ± 41.8 months. The most frequent underlying cardiac condition was dilated cardiomyopathy (58.1%), followed by hypertrophic cardiomyopathy (15.7%), arrythmogenic cardiomyopathy (2.3%), long QT syndrome (1.7%), Brugada syndrome (1.2%), catecholaminergic (2.9%) , idiopathic (7%) and others (11%). 89 ICDs (51.7%) and 83 ICD-CRTs (48.2%) were implanted for primary prevention of SCD. During follow-up, 13.4% of the patients experienced arrhythmogenic events. Only 4.1% of the patients experienced inappropriate shock, secondary to supraventricular arrhythmias all of them. Genetic testing was done in only 14.1% of our patients. In the 27 cases of hypertrophic cardiomyopathy, 25 (92.6%) underwent ICD implantation for primary prevention. 14 patients (51.9%) had family history of SCD, 8 (29.6%) had unexplained syncope and 16 (59.3%) had ventricular tachycardia in the Holter monitoring. The mean left atrial size was 44.15 ± 7.2mm, mean maximum LV-wall thickness 22.85 ± 5,25mm, and a mean LVOT gradient of 30.56 ± 31.3mmHg, with a mean actual HCM SCD-score of SCD over 5 years of 5.84 ± 3.53%. According to traditional parameters, 100% of the HCM sample meet criteria for ICD implantation in primary prevention compared to 66.7% according to the new score. During follow-up 2 patients (7.4% ) experienced arrhythmogenic events, and 3 patients (11.1%) had inappropriate shocks secondary to supraventricular arrhythmias. Genetic testing was done in 22.2% of the patients and was positive for a known pathogenic mutation in half of the cases. None of the parameters evaluated in the current score, a high risk of SCD according to it, having old high risk criteria or implanted of ICD in secondary prevention were related in our study with more arrhytmogenic events. CONCLUSIONS ICD implatation for primary prevention is the main indication in our population. Either classic factors or the new HCM SCD-score were no related in our study with the presence of arrhytmogenic events during follow-up.

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

Abstract 11447: Low Incidence of Appropriate Therapy Following Defibrillator Implantation for Primary Prevention of Sudden Cardiac Death in Hypertrophic Cardiomyopathy

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Amalie C Thavikulwat ◽  
Todd T Tomson ◽  
Bradley P Knight ◽  
Robert O Bonow ◽  
Lubna Choudhury
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Hypertrophic Cardiomyopathy ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Secondary Prevention ◽  
Cardiac Death ◽  
Icd Implantation ◽  
Icd Therapy ◽  
Appropriate Therapy

Introduction: Hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death (SCD) in young adults. Implantable cardioverter defibrillators (ICD) effectively terminate ventricular tachycardia (VT) and fibrillation (VF) that cause SCD, but the reported prevalence of and patient characteristics leading to appropriate ICD therapy in HCM have been variable. Hypothesis: We hypothesized that some risk factors may be more prevalent than others in patients with HCM who receive appropriate ICD therapy and that the overall incidence of appropriate therapy may be lower than that reported previously. Methods: We retrospectively studied all patients with HCM who were treated with ICDs at our referral center from 2000-2013 to determine the rates of appropriate and inappropriate ICD therapies. Results: Of 1136 patients with HCM, we identified 135 who underwent ICD implantation (125 for primary and 10 for secondary prevention), aged 18-81 years (mean 48±17) at the time of implantation. The mean follow-up time was 5.2±4.5 years. Appropriate ICD intervention occurred in 20 of 135 patients (2.8%/year) by providing a shock or antitachycardia pacing in response to VT or VF. The annual rate of appropriate ICD therapy was 2.4%/year for primary and 7.2%/year for secondary prevention devices. Commonly used risk factors were equally prevalent among patients who received appropriate therapy and those who did not; furthermore, the likelihood of receiving appropriate therapy in the presence of each risk factor was similar (Figure). Inappropriate ICD therapy occurred in 27 patients (3.8%/year). Conclusions: ICDs provide clear benefit to patients who experience life-threatening arrhythmias, particularly those being treated for secondary prevention. However, the appropriate therapy rate for primary prevention was lower than previously reported, and no single risk factor appeared to have stronger association with appropriate ICD therapy than others.

Abstract 86: Rates and Association of Risk Factors with Device Infection in Veterans Undergoing Cardioverter-Defibrillator Implantation Enrolled in the OVID Registry

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Preston M Schneider ◽  
David F Katz ◽  
Cara N Pelligrini ◽  
Paul A Heidenreich ◽  
Ryan G Aleong ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
A Priori ◽  
Cox Proportional Hazards ◽  
Icd Implantation ◽  
Cardiac Device ◽  
Cardioverter Defibrillator ◽  
Increased Risk ◽  
Device Infection ◽  
Social Security Death Index

Introduction: Implanted cardiac device infections are a source of significant morbidity, mortality, and cost. The rates and predictors of device infection among patients undergoing implantable cardioverter defibrillator (ICD) implantation in the VA population have not been previously described. Methods: Among veterans enrolled in the Outcomes among Veterans with Implantable Defibrillators (OVID) registry between 2003 and 2009, 3,918 were identified as within 3 months of initial ICD implantation. Baseline clinical characteristics and clinical outcomes were abstracted from the electronic medical record and social security death index. The rates of device infection were calculated per 100 person years and a priori specified predictors of device infection were examined for association with device infection using Cox proportional hazards regression. Results: Over 11,290 person years of follow up, only 76 device infections were identified for a rate of 0.67 per 100 person years (95% CI 0.54 to 0.84). Among these, 21 (27.6%) occurred within 30 days of implantation, 19 (25.0%) occurred 30 to 90 days after implantation, 8 (10.5%) occurred 90 days to 1 year after implantation, and 28 occurred greater than 1 year after implantation. The most common type of infection was a pocket infection and it was most likely to occur within 30 days of implantation. Of the examined a priori specified predictors (age, generator change, diabetes mellitus, warfarin use, chronic kidney disease and congestive heart failure), only generator change was statistically significantly associated with device infection when adjusted for comorbidities (adjusted HR 2.95; 95% CI 1.42 - 6.12). The rate of device infection among those with a generator change was 1.26 per 100 person years compared to 0.60 per 100 person years for those without a generator change. Conclusions: The overall rate of device infection in this population is lower than previously published rates and only generator change was associated with an increased risk of device infection.

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 Frequency of ventricular tachyarrhythmias in patients with different risk scores for sudden cardiac death in hypertrophic cardiomyopathy and cardioverter defibrilators implanted in primary prevention

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
N Brankovic ◽  
NN Radovanovic ◽  
N Vujadinovic ◽  
B Kircanski ◽  
V Sajic ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Cardiac Death ◽  
Ventricular Arrhythmias ◽  
Risk Scores ◽  
Icd Implantation ◽  
Life Threatening ◽  
Group A ◽  
Group B

Abstract Funding Acknowledgements Type of funding sources: None. Background The European Society of Cardiology’s (ESC) risk calculator for sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathies (HCM) is currently a tool that facilitates the decision to implant a cardioverter defibrillator (ICD) in primary prevention, but doubts still exist in everyday clinical practice. Purpose We aimed to determine the incidence of life-threatening ventricular arrhythmias during long-term follow-up in patients with different ESC HCM risk scores for SCD calculated on ICD implantation in primary prevention. Methods This retrospective, observational study was conducted in a tertiary center among adult patients with HCM and ICD devices (ICD-VR, ICD-DR and CRT-ICD) implanted in primary prevention from January 2008 to December 2019. The patients followed up for less than one year were excluded from the analysis. Study group was divided into three subgroups, according to the ESC 5 years risk score of SCD and based on it the estimated need for ICD implantation: group A with risk &lt; 4%, where ICD is generally not indicated; group B with risk 4-6%, where ICD may be considered; group C with risk ≥6%, where ICD should be considered. Regularly, ICD was interrogated twice a year, while emergency controls were performed after delivering of ICD therapy. Follow-up data including information about sustained ventricular tachicardia (VT) and ventricular fibrillation (VF) episodes were collected from patients medical records. Results In the observed period, ICD devices were implanted in 60 adult patients with HCM. Ten of them had history of sustained ventricular arrhythmias and 3 were lost to follow-up. Therefore, we analysed 47 patients (55.3% male, mean age 51.0 ± 15.7 years), 13 from group A, 12 from group B and 22 from group C. Mean follow-up period was 80.6 ± 37.9 months. During the follow-up period ventricular tachyarrhythmias (VT and VF, either in monitoring or therapy zone) were recorded in one patient from group A (7.7%), in two patients from group B (16.7%) and in 7 patients from group C (31.8%). Using Kruskal-Wallis analysis of variance, we did not find a statistically significant difference in the occurrence of ventricular tachyarrhythmias among the observed groups (p = 0.225). Conclusions Patients with HCM and a 5-year risk of SCD ≥ 6% calculated on ICD implantation had more frequent life-threatening ventricular arrhythmias during long-term follow-up, but not statistically significant. There should be an individual approach when deciding on the need for device implantation in all patients with HCM.

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