Long-term clinical outcomes after placement of an implantable cardioverter-defibrillator: does the etiology of heart failure matter?

Wasiak, Michał; Tajstra, Mateusz; Pyka, Łukasz; Gąsior, Mariusz

doi:10.33963/kp.15242

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…In this study, a total of 245 ICD interventions (appropriate and inappropriate) in 117 subjects (24%) were observed during a mean follow-up time of 15 ± 5 months. This incidence is comparable with the rate described in real-life ICD patients (Lelakowski et al, 2012;Proclemer et al, 2013;Wasiak et al, 2020;Wilkoff et al, 2004).…”

Section: Discussionsupporting

confidence: 85%

Clinical valuation of ST changes in a group of patients with ventricular arrhythmias: The inSighT Study

Wranicz

Kałowski

Bastian³

et al. 2022

Noninvasive Electrocardiol

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Background The inSighT study was designed to determine the prevalence of ischemic changes as recorded by implantable cardioverter–defibrillator (ICD) ST deviations in intracardiac electrocardiograms (EGM) over the 24 h preceding malignant ventricular arrhythmias (VT/VF). Methods The study enrolled patients with known coronary artery disease (CAD) or high risk of future development of CAD implanted with an ICD equipped with an ST monitoring feature (Ellipse™/Fortify Assura™, St. Jude Medical). Device session records were collected at each in‐clinic follow‐up. EGM ST levels of the beats over the 15 minutes prior to VT/VF events were compared using a t test with those from a baseline period of 23–24 h prior to the VT/VF event. All events with p < .05 were visually inspected to confirm they were evaluable; additional criteria for exclusion from further analysis included inappropriate therapy, aberrant conduction, and occurrence of VT/VF within 24h prior to the current event. Results The study enrolled 481 ICD patients (64 ± 11 years, 83% male) in 14 countries and followed them for 15±5 months. A total of 165 confirmed VT/VF episodes were observed, of which 71 events (in 56 patients, 34% of all patients with VT/VF) were preceded by significant (p < .05) ST‐segment changes unrelated to known non‐ischemic causes. None of the analyzed demographic and clinical factors proved to be associated with greater odds of presenting with ST‐segment changes prior to VT/VF episode. Conclusion In this exploratory study, characteristic ST‐segment changes, likely representative of ischemic events, were observed in 34% of all patients with VT/VF episodes.

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Section: Discussionsupporting

confidence: 85%

Clinical valuation of ST changes in a group of patients with ventricular arrhythmias: The inSighT Study

Wranicz

Kałowski

Bastian³

et al. 2022

Noninvasive Electrocardiol

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“…Therefore those patients had less advanced heart failure, and consequently a better prognosis. A previous Polish study proved the ischemic etiology of heart failure to be a strong predictor of mortality; however, that study did not notice any dependency of prognosis on the etiology of heart failure, regardless of the type of the device [32].…”

Section: Discussionmentioning

confidence: 78%

Follow-up and characteristics of recipients of cardiac resynchronization therapy with and without a defibrillator

Grymuza

Katarzyńska-Szymańska

Chmielewska-Michalak

et al. 2022

Kardiol Pol

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Background: Cardiac resynchronization therapy defibrillator (CRT-D) and pacemaker (CRT-P) are treatment options for patients with advanced heart failure and electrical dyssynchrony. Current guidelines provide only factors favoring, not specific recommendations as to implant CRT-D or CRT-P. This analysis aimed to compare and contrast populations of CRT-D and CRT-P recipients.Methods: Retrospective data were collected from medical records, including 231 patients treated with either CRT-D or CRT-P between 2015 and 2019. Following data were analyzed demographics, co-morbidities, pharmacotherapy, laboratory tests, and data related to the procedure of implantation. The primary endpoint of the study was all-cause mortality.Results: A total of 231 patients were included (mean age [standard deviation, SD], 64.1 [12.3] years, 76% male), of these, 13.6% (n = 32) with CRT-P and 86.4% (n = 199) with CRT-D. Mean New York Heart Association (NYHA) class did not differ between the groups: 2.23 (0.9) in CRT-P and 2.35 (0.6) in CRT-D group (P = 0.42). Mean left ventricular ejection fraction was lower in patients eligible for CRT-D: 27.1% vs. 38% (P <0.001). Patients were followed for a median (interquartile range [IQR]) of 29 (13-44) months and survival in the CRT-P group was 84%, in CRT-D -82% (P = 0.74). Patients in the CRT-P group were older, and more often after atrioventricular node ablation. The CRT-P group had tendency towards higher Charlton Comorbidity Index, reaching a mean of 4.66 (1.5) points vs. 3.96 (1.5) points in CRT-D (P = 0.06). Conclusions:Populations with CRT-P and CRT-D differ in terms of comorbidities; however, they have similar survival. Further studies are required to identify a group of patients, who derive a benefit from adding a defibrillator.

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Influence of diabetes on mortality and ICD therapies in ICD recipients: a systematic review and meta-analysis of 162,780 patients

Liu

Zhuo

et al. 2022

Cardiovasc Diabetol

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Background The influence of diabetes on the mortality and risk of implantable cardioverter defibrillator (ICD) therapies is still controversial, and a comprehensive assessment is lacking. We performed this systematic review and meta-analysis to address this controversy. Methods We systematically searched the PubMed, Embase, Web of Science and Cochrane Library databases to collect relevant literature. Fixed and random effects models were used to estimate the hazard ratio (HR) with 95% CIs. Results Thirty-six articles reporting on 162,780 ICD recipients were included in this analysis. Compared with nondiabetic ICD recipients, diabetic ICD recipients had higher all-cause mortality (HR = 1.45, 95% CI 1.36–1.55). The subgroup analysis showed that secondary prevention patients with diabetes may suffer a higher risk of all-cause mortality (HR = 1.89, 95% CI 1.56–2.28) (for subgroup analysis, P = 0.03). Cardiac mortality was also higher in ICD recipients with diabetes (HR = 1.68, 95% CI 1.35–2.08). However, diabetes had no significant effect on the risks of ICD therapies, including appropriate or inappropriate therapy, appropriate or inappropriate shock and appropriate anti-tachycardia pacing (ATP). Diabetes was associated with a decreased risk of inappropriate ATP (HR = 0.56, 95% CI 0.39–0.79). Conclusion Diabetes is associated with an increased risk of mortality in ICD recipients, especially in the secondary prevention patients, but does not significantly influence the risks of ICD therapies, indicating that the increased mortality of ICD recipients with diabetes may not be caused by arrhythmias. The survival benefits of ICD treatment in diabetes patients are limited.

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Long-term clinical outcomes after placement of an implantable cardioverter-defibrillator: does the etiology of heart failure matter?

Cited by 4 publications

References 19 publications

Clinical valuation of ST changes in a group of patients with ventricular arrhythmias: The inSighT Study

Clinical valuation of ST changes in a group of patients with ventricular arrhythmias: The inSighT Study

Follow-up and characteristics of recipients of cardiac resynchronization therapy with and without a defibrillator

Influence of diabetes on mortality and ICD therapies in ICD recipients: a systematic review and meta-analysis of 162,780 patients

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