Effects of Beta-Blockers on Implantable Cardioverter Defibrillator Therapy and Survival in the Patients with Ischemic Cardiomyopathy (from the Multicenter Automatic Defibrillator Implantation Trial-II)

Brodine, William N.; Tung, Robert; Lee, John K.; Hockstad, Eric; Moss, Arthur J.; Zaręba, Wojciech; Hall, William J.; Andrews, Mark; McNitt, Scott; Daubert, James P.

doi:10.1016/j.amjcard.2005.04.046

Cited by 87 publications

(45 citation statements)

References 17 publications

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“…15,18) Beta-blocking medication has been associated with reduced risk of adverse events in ICD treated patients with ischemic cardiomyopathy. 19,20) Consequently, the overall rate of beta-blocker use was high among patients in the current study (88%). This high rate might explain the failure of our study to demonstrate a protective effect of beta-blockers.…”

Section: Discussionmentioning

confidence: 62%

Predictors of Appropriate Implantable Cardioverter-Defibrillator Therapy During Long-Term Follow-up of Patients With Coronary Artery Disease

Blümer¹,

Wölber²,

Hellermann³

et al. 2009

Int. Heart J.

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SummaryIndications for implantable cardioverter defibrillators (ICDs) are expanding. Defining long-term predictors of ICD therapies might help to identify those patients who will benefit most from implantation of an ICD. The objective of this study was to examine longterm predictors of appropriate ICD therapy among patients with coronary disease at high risk of sudden cardiac death.An analysis of 245 patients with coronary disease, who had been implanted with an ICD for primary or secondary prevention of sudden cardiac death, was performed. Time to appropriate ICD therapy, defined as antitachycardia pacing or shock, was evaluated by the Kaplan-Meier method. Cox regression analysis was performed to determine hazard ratios for factors predicting appropriate ICD therapies.During a mean (SD) follow-up of 41 (33) months, 115 patients (53%) experienced appropriate ICD therapy. Independent predictors of appropriate ICD therapy included advanced age, left ventricular ejection fraction (LVEF) < 35%, and impaired renal function, with covariate-adjusted hazard ratios of 1.36 per 10 years (95% CI, 1.11 -1.66; P = 0.003), 1.78 (95% CI, 1.21 -2.63; P = 0.004), and 1.59 (95% CI, 1.00 -2.54; P = 0.050), respectively. Remote myocardial infarction (> 6 months prior to ICD implantation) was associated with higher probability of appropriate ICD therapy among patients with LVEF > 35% (adjusted HR 2.68 [95% CI, 1.05 -6.86; P = 0.04]), but not among patients with LVEF < 35% (adjusted HR 1.09 [95% CI, 0.58 -2.04; P = 0.79]).Left ventricular ejection fraction, advanced age, and renal impairment are long-term predictors of appropriate ICD therapy in patients with coronary disease at high risk of sudden cardiac death. Patients with an ejection fraction above 35% have few arrhythmic events early after the myocardial infarction but appropriate therapies become more frequent late after the myocardial infarction, possibly due to progression of the disease. (Int Heart J 2009; 50: 313-321)

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Section: Discussionmentioning

confidence: 62%

Predictors of Appropriate Implantable Cardioverter-Defibrillator Therapy During Long-Term Follow-up of Patients With Coronary Artery Disease

Blümer¹,

Wölber²,

Hellermann³

et al. 2009

Int. Heart J.

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“…Também têm indicação na terapia adjuvante ao cardiodesfibrilador implantável (CDI), aumentando a sua eficácia na redução da morte súbita 117 . A amiodarona não apresenta benefício na prevenção primária quando comparada ao placebo, independente da etiologia da IC, apresentando aumento da mortalidade no subgrupo isquêmico 118 .…”

Section: Antiarrítmicos (Tabela 18)unclassified

Atualização da diretriz brasileira de insuficiência cardíaca crônica - 2012

Bocchi

Marcondes‐Braga²,

Bacal³

et al. 2012

Arq. Bras. Cardiol.

221

206

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Esta atualização da Diretriz de Insuficiência Cardíaca Crônica (IC) - 2012 surge para reavaliar as recomendações através de uma avaliação criteriosa das pesquisas (considerando-se a qualidade dos estudos), fundamental para que se atinja esse propósito. Para tanto, foi dada ênfase ao efeito em desfechos de morte, à qualidade "CONSORT" (Consolidated Standards of Reporting Trials), à descrição qualitativa e quantitativa da otimização da medicação, à população realmente incluída, às metanálises somente de estudos qualidade "CONSORT", à custo-efetividade, à existência de efeito de classe, ao número de pacientes incluídos e à análise de subgrupos apenas para gerar hipóteses. Na área da epidemiologia, as recentes abordagens das características da IC com fração de ejeção preservada (ICFEP) e da importância da IC como causa de morte no Brasil foram revisadas. Além disso, este documento contempla a reavaliação do valor dos biomarcadores no diagnóstico e no seguimento da IC, o papel diagnóstico da angiotomografia coronariana nos casos de risco intermediário ou baixo risco de doença coronariana, a não recomendação de rotina do telemonitoramento; o surgimento da avaliação familiar como recomendação importante, e a reavaliação da restrição da adição de sal na dieta. As clínicas de IC e reabilitação física, apesar de alguns resultados negativos ou controversos quanto à mortalidade, continuam com recomendação importante. No campo do tratamento farmacológico, abrange-se a reavaliação da indicação do nebivolol, introduz-se a ivabradina como um novo paradigma no tratamento, os antagonistas da aldosterona não têm efeito de classe reconhecido, o ômega 3 passa a ser recomendado, o ferro administrado por via endovenosa e o sildenafil recebem indicação em casos selecionados. Todas as recomendações para outras etiologias são expandidas para a Doença de Chagas. Na área da anticoagulação, recomenda-se a utilização dos escores CHA2DS2VASC e o HAS-BLED na fibrilação atrial, com introdução de inibidores da trombina e do fator Xa como alternativas na anticoagulação. No tratamento cirúrgico da IC, considerou-se que resultados neutros do estudo STICH influenciaram as recomendações, o transplante cardíaco continua a ser o tratamento indicado nas fases evolutivas tardias de IC, os dispositivos de assistência circulatória mecânica para terapia de destino passam a ter recomendação, a duração do QRS foi fundamental na indicação de TRV-AV, e o CDI continua com recomendação I para miocardiopatia isquêmica. Entretanto, baseada em análise crítica dos estudos considerando-se o custo-efetividade, o CDI não atingiu recomendação I para classes menos graves devido as limitações dos estudos. Também a importância da cardiotoxicidade por drogas para tratamento de neoplasias foi ressaltada, o tratamento da IC na gravidez e da miocardite foi revisado. Novos potenciais métodos de tratamento em fase de pesquisa são apresentados e novos fluxogramas de diagnóstico e tratamento da IC, reformulados, foram incluído

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“…Previous reports have demonstrated that β-blockers decrease the incidence of sudden death and arrhythmia in HFrEF patients. [26][27][28][29][30][31] In our study population, 81.0% of the subjects were taking β-blockers which is in clear contrast to the aforementioned studies where approximately 30-70% of the patients were taking β-block ers. 6,10,12,28) This might explain the different outcome between those studies and our study.…”

Section: Discussionmentioning

confidence: 73%

Effects of Long-Acting Loop Diuretics in Heart Failure With Reduced Ejection Fraction Patients With Cardiac Resynchronization Therapy

et al. 2017

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SummaryThere have been no reports evaluating the impact of long-acting loop diuretics (LLD) on the outcome of heart failure (HF) and arrhythmia treatment in HF with reduced ejection fraction (HFrEF) patients implanted with a cardiac resynchronization therapy (CRT) device.This was a prospective, single-blind, randomized crossover study. We allocated 21 consecutive CRT implanted patients into 2 groups. The furosemide group received furosemide as a first treatment and azosemide as a second treatment. The azosemide group received this treatment in the reverse order. The first treatment was given to each group for 6 months and the second treatment continued for an additional 6 months. We combined the data of each medication regimen in each group and analyzed it at baseline, 6 months, and 1 year. The primary endpoints were the variation of fluid index and thoracic impedance measured by CRT at 6 months.The baseline characteristics were similar for both groups. The difference in the primary endpoints was not statistically significant between the 2 medication arms (fluid index: -29.6 ± 64.4 versus 16.2 ± 48.2; P = 0.22, thoracic impedance: -0.49 ± 17.8 versus 2.45 ± 12.5; P = 0.56). Likewise, the clinical outcome of HF and the CRT derived parameters in both arms were comparable.HFrEF patients taking LLD after CRT implantation might be comparable to those taking short-acting loop diuretics in the treatment of HF and HF-associated arrhythmias. (Int Heart J 2017; 58: 211-219)

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Effects of Beta-Blockers on Implantable Cardioverter Defibrillator Therapy and Survival in the Patients with Ischemic Cardiomyopathy (from the Multicenter Automatic Defibrillator Implantation Trial-II)

Cited by 87 publications

References 17 publications

Predictors of Appropriate Implantable Cardioverter-Defibrillator Therapy During Long-Term Follow-up of Patients With Coronary Artery Disease

Predictors of Appropriate Implantable Cardioverter-Defibrillator Therapy During Long-Term Follow-up of Patients With Coronary Artery Disease

Atualização da diretriz brasileira de insuficiência cardíaca crônica - 2012

Effects of Long-Acting Loop Diuretics in Heart Failure With Reduced Ejection Fraction Patients With Cardiac Resynchronization Therapy

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