Increased risk of ventricular arrhythmias in survivors of out-of-hospital cardiac arrest with chronic total coronary occlusion

Yap, Sing‐Chien; Sakhi, Rafi; Theuns, Dominic; Yasar, Yunus E.; Bhagwandien, Rohit; Diletti, Roberto; Zijlstra, Felix; Szili-Török, Tamás

doi:10.1016/j.hrthm.2017.09.004

Cited by 26 publications

(39 citation statements)

References 24 publications

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“…Previous published studies8, 9, 10, 16, 17 have shown a trend towards higher appropriate device therapy and all‐cause mortality rates in ICD patients with a CTO. Also, the presence of a CTO has proven to be associated with a worse survival compared with patients with SVD or MVD without a CTO 3, 4.…”

Section: Discussionmentioning

confidence: 93%

Evaluation of the Impact of a Chronic Total Coronary Occlusion on Ventricular Arrhythmias and Long‐Term Mortality in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter‐Defibrillator (the eCTOpy‐in‐ICD Study)

Dongen

Yılmaz

Elias

et al. 2018

JAHA

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BackgroundPrevious studies report conflicting results about a higher incidence of ventricular arrhythmias in patients with a chronic total coronary occlusion (CTO). We aimed to investigate this association in a large cohort of implantable cardioverter defibrillator patients with long‐term follow‐up.Methods and ResultsAll consecutive patients from 1992 onwards who underwent implantable cardioverter defibrillator implantation for ischemic cardiomyopathy at the Leiden University Medical Center were evaluated. Coronary angiograms were reviewed for the presence of a CTO. The occurrence of ventricular arrhythmias and survival status at follow‐up were compared between patients with and patients without a CTO. A total of 722 patients constitute the study cohort (age 66±11 years; 84% males; 74% primary prevention, median left ventricular ejection fraction 30% [first–third quartile: 25–37], 44% received a cardiac resynchronization therapy defibrillator). At baseline, 240 patients (33%) had a CTO, and the CTOs were present for at least 44 (2–127) months. The median follow‐up duration was 4 (2–6) years. On long‐term follow‐up, CTO patients had a higher crude appropriate device therapy rate (37% versus 27%, P=0.010) and a lower crude survival rate (51% versus 67%, P<0.001) compared with patients without a CTO. Corrected for baseline characteristics including left ventricular ejection fraction, the presence of a CTO was an independent predictor for appropriate device therapy.ConclusionsThe presence of a CTO in implantable cardioverter defibrillator patients was associated with more appropriate device therapy and worse prognosis at long‐term follow‐up. Further investigation is warranted regarding a potential beneficial effect of CTO revascularization on the incidence of ventricular arrhythmias.

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Section: Discussionmentioning

confidence: 93%

Evaluation of the Impact of a Chronic Total Coronary Occlusion on Ventricular Arrhythmias and Long‐Term Mortality in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter‐Defibrillator (the eCTOpy‐in‐ICD Study)

Dongen

Yılmaz

Elias

et al. 2018

JAHA

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“…Werner and Jang showed that in asymptomatic patients, cardiac function improvements post-CTO PCI are relevant [9]. CTO treatment could also increase reverse remodeling and decrease the risk of ventricular arrhythmias, even in older patients [6,7,9,18,94]. The CREDO-Kyoto registry demonstrated that successful CTO-PCIs are associated with less need for subsequent CABG with respect to unsuccessful ones, while no difference was highlighted in terms of 3-year mortality [95].…”

Section: Short and Long Term Results Of Cto-pcimentioning

confidence: 99%

“…Patients with CTOs often presented an impaired left ventricular function, prior MI, coronary artery bypass grafting (CABG), and a high rate of comorbidity, such as diabetes mellitus and chronic kidney disease [13,14,17]. The presence of a CTO could also increase the incidence of ventricular arrhythmias in survivors of out-of-hospital cardiac arrest and in patients with a CTO in IRA [18][19][20].…”

Section: The Patient With a Coronary Chronic Total Occlusionmentioning

confidence: 99%

Current approaches for treatment of coronary chronic occlusions

Iannaccone

Scarparo

Wilschut

et al. 2019

Expert Review of Medical Devices

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Introduction: Coronary chronic total occlusions (CTO) represent a challenging subset in interventional cardiology. Areas covered: During the last decade, improvements in materials, techniques, and meticulous preprocedural lesion assessment have increased the success rate in CTO lesions. Several scores have been developed to address overall lesion evaluation and help select the most appropriate treatment strategy. In addition, specific algorithms such as the hybrid algorithm have been introduced to provide a framework for CTO operators and a rapid management of the various challenging aspects of the procedure. The hybrid approach requires operator's ability to switch from one treatment strategy to another when the first one appears to be unsuccessful. Adequate training and operators' experience remain crucial to improve the likelihood of success. Expert opinion: The aim of this review is to provide insights and guidance for operators on current approaches for treatment of CTO and complication management.

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“…The last decade, several studies have evaluated the association between CTO and the occurrence of VA in ICD recipients with coronary artery disease [5][6][7][8]32] (Table 1). One of the first studies was published in 2012 by Nombela-Franco et al (VACTO Primary Study) [6].…”

Section: Cto In Icd Recipientsmentioning

confidence: 99%

“…The presence of a chronic total occlusion (CTO) is associated with an increased risk of sudden cardiac death (SCD) [1-2-3-4]. This seems to be mainly driven by a higher risk of ventricular arrhythmias (VAs) [1,[5][6][7][8]. There is emerging clinical evidence that the presence of a CTO has a proarrhythmic effect [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Vulnerability for ventricular arrhythmias in patients with chronic coronary total occlusion

Assaf

Diletti

Hoogendijk

et al. 2020

Expert Review of Cardiovascular Therapy

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Introduction: The presence of a chronic total occlusion (CTO) is associated with an increased risk of ventricular arrhythmias. Areas covered: This review provides an overview of the relationship between CTO and ventricular arrhythmias, arrhythmogenic mechanisms, and the effect of revascularization. Expert opinion: Studies in recipients of an implantable cardioverter-defibrillator (ICD) have shown that a CTO is an independent predictor of appropriate ICD therapy. The myocardial territory supplied by a CTO is a pro-arrhythmogenic milieu characterized by scar tissue, large scar border zone, hibernating myocardium, residual ischemia despite collaterals, areas of slow conduction, and heterogeneity in repolarization. Restoring coronary flow by revascularization might be associated with electrical homogenization as reflected by a decrease in QT(c) dispersion, decrease in T wave peak-to-end interval, reduction of late potentials, and decrease in scar border zone area. Future research should explore whether CTO revascularization results in a lower burden of ventricular arrhythmias. Furthermore, risk stratification of CTO patients without severe LV dysfunction is interesting to identify potential ICD candidates. Potential tools for risk stratification are the use of electrocardiographic parameters, body surface mapping, electrophysiological study, and close rhythm monitoring using an insertable cardiac monitor.

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Increased risk of ventricular arrhythmias in survivors of out-of-hospital cardiac arrest with chronic total coronary occlusion

Abstract: In OHCA survivors with coronary artery disease receiving an ICD for secondary prevention, CTO was an independent predictor for the occurrence of ventricular arrhythmias but not for mortality.

Cited by 26 publications

References 24 publications

Evaluation of the Impact of a Chronic Total Coronary Occlusion on Ventricular Arrhythmias and Long‐Term Mortality in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter‐Defibrillator (the eCTOpy‐in‐ICD Study)

Evaluation of the Impact of a Chronic Total Coronary Occlusion on Ventricular Arrhythmias and Long‐Term Mortality in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter‐Defibrillator (the eCTOpy‐in‐ICD Study)

Current approaches for treatment of coronary chronic occlusions

Vulnerability for ventricular arrhythmias in patients with chronic coronary total occlusion

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