A comparison of long-standing implantable cardioverter-defibrillator patients with and without appropriate therapy for ventricular arrhythmias: impact of a widening QRS

Dizon, José; Chen, Kimberly; Dizon, Samantha; Biviano, Angelo; Whang, William; Ehlert, Frederick A.; Vázquez, Jesús; Nazif, Tamim; Garan, Hasan

doi:10.1093/europace/euq363

Cited by 3 publications

(1 citation statement)

References 20 publications

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“…Previous studies have tried to identify predictors of appropriate ICD therapies, including atrial fibrillation (AF) [7] [8], renal dysfunction [9], advanced New York Heart Association (NYHA) class [10], age [10], gender [11] [12] and parameters of electrical instability or arrhythmic substrate [13]. However, all those trials included different patient populations, so it is very difficult to draw conclusions for clinical decision.…”

Section: Introductionmentioning

confidence: 99%

Clinical Predictors of Appropriate Implantable Cardioverter-Defibrillator Therapies in Primary Prevention: A Retrospective Study

Devecchi¹,

Occhetta²,

Galiffa³

et al. 2017

WJCD

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Implantable cardioverter-defibrillator (ICD) in heart failure with reduced ejection fraction (EF) patients reduces risk for sudden cardiac death (SCD). Previous data suggest that the benefit of ICD therapy in real life may be lower than expected from the results of controlled studies and only about one-third of ICD patients receive appropriate therapies. Nevertheless, all ICD patients are at risk of perioperative complications and inappropriate shocks. We retrospectively studied 613 patients undergoing ICD for primary prevention in 2002-2015; we excluded inherited arrhythmogenic syndromes. Patients underwent 12-leads ECG, echocardiography, laboratory tests and quality of life questionnaire. We evaluated comorbidities, appropriate therapies, complications and all-cause mortality. Consecutive patients (age 67 ± 10 years, 81% males, 59% ischaemic aetiology) were followed for 51 ± 31 months. 198 patients (32%) received appropriate ICD therapy, 93 (15%) had inappropriate shocks, 53 (8%) had at least one complication (electrode dysfunction, infection and pocket related) and 191 (33%) died. Multivariate analysis showed atrial fibrillation (OR = 1.8, CI = 1.27 -2.53; p < 0.01), diabetes (OR = 1.8, CI = 1.27 -2.53; p = 0.041) and vasculopathy (OR = 1.8, CI = 1.27 -2.53; p = 0.031) as predictors of appropriate therapy. Logistic regression, considering atrial fibrillation, diabetes, vasculopathy, EF, NYHA class, left atrial diameter and natremia, identified SCD low risk group (probability < 0.1258). Ventricular arrhythmias necessitating ICD therapy are common, but complications and inappropriate therapies are frequent. Many parameters should be considered for a better selection of ICD candidates, to reduce ineffective implants. Our multifactorial score may eventually reduce about 10% ICD implantation.

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Section: Introductionmentioning

confidence: 99%

Clinical Predictors of Appropriate Implantable Cardioverter-Defibrillator Therapies in Primary Prevention: A Retrospective Study

Devecchi¹,

Occhetta²,

Galiffa³

et al. 2017

WJCD

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Intracardiac QT integral on far-field ICD electrogram predicts sustained ventricular tachyarrhythmias in ICD patients

et al. 2011

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Differences in predictors of implantable cardioverter-defibrillator therapies in patients with ischaemic and non-ischaemic cardiomyopathies

Darma¹,

Nedios²,

Kosiuk³

et al. 2015

Europace

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A comparison of long-standing implantable cardioverter-defibrillator patients with and without appropriate therapy for ventricular arrhythmias: impact of a widening QRS

Abstract: In this study of patients with long-standing ICDs, the only discriminating factors for appropriate shocks were implant for secondary prevention or increasing QRS width, suggesting electrical factors are the best predictors of ultimate ICD discharges.

Cited by 3 publications

References 20 publications

Clinical Predictors of Appropriate Implantable Cardioverter-Defibrillator Therapies in Primary Prevention: A Retrospective Study

Clinical Predictors of Appropriate Implantable Cardioverter-Defibrillator Therapies in Primary Prevention: A Retrospective Study

Intracardiac QT integral on far-field ICD electrogram predicts sustained ventricular tachyarrhythmias in ICD patients

Differences in predictors of implantable cardioverter-defibrillator therapies in patients with ischaemic and non-ischaemic cardiomyopathies

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