Factors Influencing Appropriate Firing of the Implanted Defibrillator for Ventricular Tachycardia/Fibrillation

Singh, Jagmeet P.; Hall, William J.; McNitt, Scott; Wang, Hongyue; Daubert, James P.; Zaręba, Wojciech; Ruskin, Jeremy N.; Moss, Arthur J.; Investigators, Madit-Ii

doi:10.1016/j.jacc.2005.05.088

Cited by 157 publications

(99 citation statements)

References 30 publications

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“…However, this finding is in contrast to other studies, which did not find an association of age with increased risk of ICD therapy or mortality during shorter follow-up periods. 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%).…”

Section: Discussionmentioning

confidence: 99%

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: 99%

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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“…Higher rates of therapy in men have been reported from clinical trials34 and other observational studies 30, 32, 35, 36. The mechanisms for this are unclear, but men may be more likely to develop malignant ventricular arrhythmias compared with women, which may also explain greater ICD efficacy observed in men in some studies 37.…”

Section: Discussionmentioning

confidence: 93%

Device Therapies Among Patients Receiving Primary Prevention Implantable Cardioverter‐Defibrillators in the Cardiovascular Research Network

Greenlee

Peterson

et al. 2018

JAHA

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BackgroundPrimary prevention implantable cardioverter‐defibrillators (ICDs) reduce mortality in selected patients with left ventricular systolic dysfunction by delivering therapies (antitachycardia pacing or shocks) to terminate potentially lethal arrhythmias; inappropriate therapies also occur. We assessed device therapies among adults receiving primary prevention ICDs in 7 healthcare systems.Methods and ResultsWe linked medical record data, adjudicated device therapies, and the National Cardiovascular Data Registry ICD Registry. Survival analysis evaluated therapy probability and predictors after ICD implant from 2006 to 2009, with attention to Centers for Medicare and Medicaid Services Coverage With Evidence Development subgroups: left ventricular ejection fraction, 31% to 35%; nonischemic cardiomyopathy <9 months’ duration; and New York Heart Association class IV heart failure with cardiac resynchronization therapy defibrillator. Among 2540 patients, 35% were <65 years old, 26% were women, and 59% were white. During 27 (median) months, 738 (29%) received ≥1 therapy. Three‐year therapy risk was 36% (appropriate, 24%; inappropriate, 12%). Appropriate therapy was more common in men (adjusted hazard ratio [HR], 1.84; 95% confidence interval [CI], 1.43–2.35). Inappropriate therapy was more common in patients with atrial fibrillation (adjusted HR, 2.20; 95% CI, 1.68–2.87), but less common among patients ≥65 years old versus younger (adjusted HR, 0.72; 95% CI, 0.54–0.95) and in recent implants (eg, in 2009 versus 2006; adjusted HR, 0.66; 95% CI, 0.46–0.95). In Centers for Medicare and Medicaid Services Coverage With Evidence Development analysis, inappropriate therapy was less common with cardiac resynchronization therapy defibrillator versus single chamber (adjusted HR, 0.55; 95% CI, 0.36–0.84); therapy risk did not otherwise differ for Centers for Medicare and Medicaid Services Coverage With Evidence Development subgroups.ConclusionsIn this community cohort of primary prevention patients receiving ICD, therapy delivery varied across demographic and clinical characteristics, but did not differ meaningfully for Centers for Medicare and Medicaid Services Coverage With Evidence Development subgroups.

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“…In the MADIT‐II, patients were randomized to receive a prophylactic implantable cardioverter‐defibrillator or conventional medical therapy at a 3:2 ratio. In patients with an implantable cardioverter‐defibrillator, however, obesity (BMI ≥30 kg/m 2 ) was a significant risk factor for ventricular tachyarrhythmias requiring appropriate implantable cardioverter‐defibrillator therapy 10. From these results, obesity might contribute to the development of tachyarrhythmia, which can lead to SCD, in high‐risk patients after MI.…”

Section: Discussionmentioning

confidence: 99%

“…Recent large population‐based cohort studies have reported that higher BMI is associated with an increased risk of SCD, although these findings are controversial 7, 8. Data on the association between obesity and the risk of SCD and ventricular tachyarrhythmias in patients with MI are limited 9, 10, 11. Moreover, whether obese patients who survive an acute MI have a long‐term risk of SCD is unclear.…”

Section: Introductionmentioning

confidence: 99%

Body Mass Index and Sudden Cardiac Death in Japanese Patients After Acute Myocardial Infarction: Data From the JCAD Study and HIJAMI‐II Registry

Shiga

Kohro

Yamasaki

et al. 2018

JAHA

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BackgroundAlthough an “obesity paradox” exists in patients after myocardial infarction, the association between obesity and the risk of sudden cardiac death (SCD) is limited. The aim of this study was to determine whether obesity is associated with an increased risk of SCD in Japanese survivors of acute myocardial infarction.Methods and ResultsPooled data from 2 cohort studies in Japan, JCAD (Japanese Coronary Artery Disease) study and the Heart Institute of Japan Acute Myocardial Infarction‐II (HIJAMI‐II) registry, comprising of 6216 patients (mean age 65±11 years, 75.2% male) with acute myocardial infarction who were discharged alive, were studied. The patients were categorized into the following body mass index (BMI) groups at baseline according to the World Health Organization classification for Asian populations: BMI <18.5 kg/m2 (n=335), 18.5 to 23 kg/m2 (n=2371), 23 to 27.5 kg/m2 (n=2823), and ≥27.5 kg/m2 (n=687). The main outcomes were all‐cause mortality and SCD. During an average follow‐up period of 3.6±1.4 years, all‐cause mortality was 10.1%, and SCD was 1.2%. Patients with BMI <18.5 kg/m2 had the highest rate of all‐cause mortality (adjusted hazard ratio, 1.61; 95% confidence interval, 1.20–2.16), but high BMI (≥27.5 kg/m2) was not associated with mortality compared with patients in the group with BMI ≥18.5 and <23 kg/m2. However, the long‐term risk of SCD was increased in the group with BMI ≥27.5 kg/m2 (adjusted hazard ratio, 2.97; 95% confidence interval, 1.24–7.15). Multivariate analysis revealed that BMI ≥27.5 kg/m2 was associated with an increased risk of SCD (hazard ratio, 2.78; 95% confidence interval, 1.35–5.74).ConclusionsObesity (BMI ≥27.5 kg/m2) was associated with the risk of SCD in Japanese patients after myocardial infarction, although an obesity paradox was found for all‐cause mortality.

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Factors Influencing Appropriate Firing of the Implanted Defibrillator for Ventricular Tachycardia/Fibrillation

Abstract: These results provide important mechanistic information, suggesting that worsening clinical condition and cardiac instability, as reflected by an IH-CHF or IH-CE, are subsequently associated with a significant increase in the risk for appropriate ICD therapy (for VT/VF) and death.

Cited by 157 publications

References 30 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

Device Therapies Among Patients Receiving Primary Prevention Implantable Cardioverter‐Defibrillators in the Cardiovascular Research Network

Body Mass Index and Sudden Cardiac Death in Japanese Patients After Acute Myocardial Infarction: Data From the JCAD Study and HIJAMI‐II Registry

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