An inappropriate pacing threshold increase after repeated electrical storm in a patient with implantable cardioverter defibrillator

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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163 Radiofrequency catheter ablation for drug refractory electrical storm in implantable cardioverter defibrillator recipients

EP Europace ◽

10.1016/eupace/7.supplement_1.27-b ◽

2005 ◽

Vol 7 (Supplement_1) ◽

pp. 27-28

Author(s):

K. Fukuzawa ◽

A. Yoshida ◽

H. Kitamura ◽

S. Kubo ◽

T. Takano ◽

...

Keyword(s):

Catheter Ablation ◽

Implantable Cardioverter Defibrillator ◽

Radiofrequency Catheter Ablation ◽

Electrical Storm ◽

Cardioverter Defibrillator

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ELECTRICAL STORM IN CHAGAS HEART DISEASE PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATOR - CLINICAL PREDICTORS, OUTCOME AND ARRHYTHMIC CHARACTERISTICS: A PROSPECTIVE REGISTRY FROM A UNIVERSITY HOSPITAL

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(20)32914-4 ◽

2020 ◽

Vol 75 (11) ◽

pp. 2287

Author(s):

Maria Licia Ribeiro Cury Pavao ◽

Elerson Arfelli ◽

Adilson Scorzoni Filho ◽

Rafael Brolio Pavao ◽

Antonio Pazin Filho ◽

...

Keyword(s):

Heart Disease ◽

Implantable Cardioverter Defibrillator ◽

University Hospital ◽

Electrical Storm ◽

Clinical Predictors ◽

Cardioverter Defibrillator ◽

Chagas Heart Disease

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Electrical storm in patients with biventricular implantable cardioverter defibrillator: Incidence, predictors, and prognostic implications

American Heart Journal ◽

10.1016/j.ahj.2008.06.035 ◽

2008 ◽

Vol 156 (5) ◽

pp. 847-854 ◽

Cited By ~ 17

Author(s):

Maurizio Gasparini ◽

Maurizio Lunati ◽

Maurizio Landolina ◽

Massimo Santini ◽

Luigi Padeletti ◽

...

Keyword(s):

Implantable Cardioverter Defibrillator ◽

Electrical Storm ◽

Cardioverter Defibrillator ◽

Prognostic Implications

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The Effect of Sacubitril/Valsartan on Device Detected Arrhythmias and Electrical Parameters among Dilated Cardiomyopathy Patients with Reduced Ejection Fraction and Implantable Cardioverter Defibrillator

Journal of Clinical Medicine ◽

10.3390/jcm9041111 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1111 ◽

Cited By ~ 1

Author(s):

Vincenzo Russo ◽

Roberta Bottino ◽

Anna Rago ◽

Andrea Antonio Papa ◽

Biagio Liccardo ◽

...

Keyword(s):

Ejection Fraction ◽

Dilated Cardiomyopathy ◽

Implantable Cardioverter Defibrillator ◽

Reverse Remodeling ◽

Electrical Parameters ◽

Pacing Threshold ◽

Reduced Ejection Fraction ◽

Cardioverter Defibrillator ◽

Echocardiographic Parameters

Sacubitril/valsartan therapy reduces sudden cardiac death (SCD) among patients with reduced ejection fraction (HFrEF) when compared to guidelines recommended doses of enalapril, however the mechanism is still not clear. There are few, contrasting results about the effect of sacubitril/valsartan on arrhythmias in the clinical context of dilated cardiomyopathy (DCM) and there are no clinical data about its effect on measured implantable cardioverter defibrillator (ICD) electrical parameters, such as atrial/ventricular electrograms sensing and pacing threshold. We conducted a 12 month follow-up observational study in 167 ischemic and nonischemic DCM patients (mean age 68.1 ± 11.6 years; 85% male), with dual-chamber ICD on sacubitril/valsartan treatment, to evaluate the incidence of device detected tachyarrhythmia events, both atrial and ventricular, and the change in measured ICD electrical parameters. We collected data on clinical, electrocardiographic and echocardiographic parameters to find a possible electro-mechanical correlation within results. Our results show that DCM patients with reduced ejection fraction and ICD on sacubitril/valsartan treatment experienced a reduction in both atrial and ventricular arrhythmias incidence and an improvement in ICD electrical atrial parameters. The findings might be explained by the electro-mechanical cardiac reverse remodeling induced by sacubitril/valsartan therapy.

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