Impact of accelerated ventricular tachyarrhythmias on mortality in patients with implantable cardioverter-defibrillator therapy

Schukro, Christoph; Leitner, Lukas; Siebermair, Johannes; Pezawas, Thomas; Stix, Günter; Kästner, Johannes; Schmidinger, Herwig

doi:10.1016/j.ijcard.2012.09.015

Cited by 30 publications

(6 citation statements)

References 21 publications

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“…In our total cohort of IVF patients, we did not find any case of accelerated ventricular tachyarrhythmia after appropriate and inappropriate ICD therapies. This is in line with a previously published finding from our institution, where acceleration of ventricular tachyarrhythmia—mainly triggered by appropriate ATP—has shown to be a complication that predominantly affects patients with structural heart disease, mainly with reduced left ventricular systolic function [ 30 ].…”

Section: Discussionsupporting

confidence: 92%

Prevalence of early repolarization syndrome and long-term clinical outcome in patients with the diagnosis of idiopathic ventricular fibrillation

Fiedler¹,

Radojevic

Sponder

et al. 2018

Heart Vessels

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Idiopathic ventricular fibrillation (IVF) is diagnosed in up to 14% of sudden cardiac death (SCD) survivors. Early repolarization syndrome (ERS) in patients with ventricular tachyarrhythmia is characterized by an elevated J-point in inferior and/or antero-lateral leads. Our objectives were to determine the prevalence of ERS in IVF patients, and to evaluate potential differences in clinical outcome. Out of 3,552 implantable cardioverter defibrillator (ICD) carriers, 758 SCD survivors were retrospectively identified from the databases of the Medical Universities of Vienna and Innsbruck within the last three decades. Early repolarization pattern (ERP) was classified either as "notching" or "slurring". Endpoints were defined as appropriate ICD therapies for ventricular tachyarrhythmia, either anti-tachycardia pacing or shock, and all-cause mortality. After exclusion of recognized reasons for SCD, 50 patients were assigned to the diagnosis of IVF (6.6%). An ERP was identified in 10 patients, most of them with notching ( n = 8). After a mean follow-up of 11.2 ± 6.7 years (539.3 patient years), appropriate ICD therapies were found in 50% of ERS and 43% of IVF patients without ERP ( p = 0.732). In ERS patients, all ICD therapies were found in patients with notching pattern. Similarly, incidence of inappropriate ICD therapies, and all-cause mortality was comparable (30% vs. 23%, p = 0.707; 10% vs. 5%, p = 0.496, respectively). In 758 SCD survivors, we found a low prevalence of IVF and ERS. Similar event rates were reported concerning all-cause mortality and ICD therapies for ventricular tachyarrhythmia after long-term follow-up in this cohort.

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Section: Discussionsupporting

confidence: 92%

Prevalence of early repolarization syndrome and long-term clinical outcome in patients with the diagnosis of idiopathic ventricular fibrillation

Fiedler¹,

Radojevic

Sponder

et al. 2018

Heart Vessels

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“…It has been indicated that VT acceleration by ATP might lead to electric storms and a higher mortality. 10 Whereas there was no difference in mortality in the PRAETORIAN trial, 4 patients with a TV-ICD indeed had a higher risk of electric storms compared with patients with an S-ICD, despite the comparable baseline. In this study, ATP had a proarrhythmogenic effect in 9.4% of the episodes.…”

Section: Discussionmentioning

confidence: 94%

“…The reported efficacy ranges from 52% to 81%, and some studies have observed higher mortality in patients treated by ATP. [6][7][8][9][10] Because of its extrathoracic design, S-ICD is incapable of providing pacing therapy, including ATP. 11,12 In this prespecified secondary analysis of the PRAETORIAN trial, we aimed to determine the efficacy and safety of ATP and shocks by comparing appropriate therapies in S-ICD and TV-ICD and investigated whether ATP reduced the number of appropriate ICD shocks.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Appropriate Shocks and Antitachycardia Pacing in Transvenous and Subcutaneous Implantable Defibrillators: Analysis of All Appropriate Therapy in the PRAETORIAN Trial

et al. 2022

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Background: The PRAETORIAN trial showed non-inferiority of the subcutaneous implantable cardioverter-defibrillator (S-ICD) compared to the transvenous ICD (TV-ICD) with regard to inappropriate shocks and complications. In contrast to the TV-ICD, the S-ICD cannot provide antitachycardia pacing (ATP) for monomorphic ventricular tachycardia (VT). This pre-specified secondary analysis evaluates appropriate therapy and whether ATP reduces the number of appropriate shocks. Methods: The PRAETORIAN trial was an international, investigator-initiated randomized trial, which included patients with an indication for ICD therapy. Patients with prior VTs below 170 bpm or refractory recurrent monomorphic VTs were excluded. In 39 centers, 849 patients were randomized to receive an S-ICD (N=426) or TV-ICD (N=423) and were followed for a median of 49.1 months. ICD programming was mandated by protocol. Appropriate ICD therapy was defined as therapy for ventricular arrhythmias. Arrhythmias were classified as discrete episodes and storm episodes (≥3 episodes within 24 hours). Analyses were performed in the modified intention-to-treat population. Results: In the S-ICD group, 86/426 patients received appropriate therapy, versus 78/423 patients in the TV-ICD group, during a median follow-up of 52 months (48-month Kaplan-Meier estimates 19.4% and 17.5%, P=0.45). In the S-ICD group, 83 patients received at least one shock, versus 57 patients in the TV-ICD group (48-month Kaplan-Meier estimates 19.2% and 11.5%, P=0.02). Patients in the S-ICD group had a total of 254 shocks, compared to 228 shocks in the TV-ICD group (P=0.68). First shock efficacy was 93.8% in the S-ICD group and 91.6% in the TV-ICD group (P=0.40). The first ATP attempt successfully terminated 46% of all monomorphic VTs, but accelerated the arrhythmia in 9.4%. Ten S-ICD patients experienced 13 electrical storms, versus 18 TV-ICD patients with 19 electrical storms. Patients with appropriate therapy had an almost two-fold increased relative risk of electrical storms in the TV-ICD group compared to the S-ICD group (P=0.05). Conclusions: In this trial, no difference was observed in shock efficacy of the S-ICD compared with the TV-ICD. Although patients in the S-ICD group were more likely to receive an ICD shock, the total number of appropriate shocks was not different between the two groups.

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“…However, ATP should be programmed more conservatively, since the randomized MADIT‐RIT trial revealed a higher mortality associated with appropriate ATP therapies in the “conventional” (empiric) ICD programming arm 57 . One explanation for this finding might be a significantly higher mortality in patients with accelerated VT following appropriate ATP intervention 58 …”

Section: Future Perspectivesmentioning

confidence: 99%

State‐of‐the‐art consensus on non‐transvenous implantable cardioverter‐defibrillator therapy

Schukro

Santer

Prenner

et al. 2020

Clinical Cardiology

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Within the last decade, implantable cardioverter-defibrillator (ICD) systems with nontransvenous leads were developed in order to minimize complications related to the cardiovascular position of transvenous ICD leads. This national expert consensus gives an overview of potential indications for the implantation of non-transvenous ICD systems, and provides specific recommendations for implantation, follow-up, and complication management in patients with subcutaneous ICD. Regarding particular issues like the necessity for shock efficacy testing, or the clinical outcome as compared to transvenous ICD, randomized data are expected in the near future.

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Impact of accelerated ventricular tachyarrhythmias on mortality in patients with implantable cardioverter-defibrillator therapy

Cited by 30 publications

References 21 publications

Prevalence of early repolarization syndrome and long-term clinical outcome in patients with the diagnosis of idiopathic ventricular fibrillation

Prevalence of early repolarization syndrome and long-term clinical outcome in patients with the diagnosis of idiopathic ventricular fibrillation

Efficacy and Safety of Appropriate Shocks and Antitachycardia Pacing in Transvenous and Subcutaneous Implantable Defibrillators: Analysis of All Appropriate Therapy in the PRAETORIAN Trial

State‐of‐the‐art consensus on non‐transvenous implantable cardioverter‐defibrillator therapy

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