Usefulness of Atrial Fibrillation as a Marker for Adverse Cardiovascular Outcomes in Both Primary and Secondary Prevention in Patients With Implantable Cardioverter-Defibrillators

Chang, Ian C; Agamawi, Yusuf M.; Austin, Erin; Adkisson, Wayne O.; Roukoz, Henri; Wald, Lisa N. von; Sakaguchi, Scott; Benditt, David G.; Chen, Lin Y.

doi:10.1016/j.amjcard.2016.08.016

Cited by 6 publications

(5 citation statements)

References 30 publications

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“…Especially AF represents an important predictor of ventricular tachyarrhythmia and SCD. An increased risk of tachyarrhythmia goes along with a higher incidence of short-long cycles that can degenerate into VT among AF patients [9, 31, 32]. It may therefore be assumed that the increased risk of recurrence of ventricular tachyarrhythmia is triggered by the interaction of digitalis and AF, rather than by digitalis therapy its own.…”

Section: Discussionmentioning

confidence: 99%

Digitalis Therapy and Risk of Recurrent Ventricular Tachyarrhythmias and ICD Therapies in Atrial Fibrillation and Heart Failure

et al. 2019

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Objective: This study sought to assess the impact of treatment with digitalis on recurrences of ventricular tachyarrhythmias in implantable cardioverter defibrillator (ICD) recipients with atrial fibrillation (AF) and heart failure (HF). Background: The data regarding outcomes of digitalis therapy in ICD recipients are limited. Methods: A large retrospective registry was used, including consecutive ICD recipients with episodes of ventricular tachyarrhythmia between 2002 and 2016. Patients treated with digitalis were compared to patients without digitalis treatment. The primary prognostic outcome was first recurrence of ventricular tachyarrhythmia at 5 years. Kaplan-Meier and multivariable Cox regression analyses were applied. Results: A total of 394 ICD recipients with AF and/or HF was included (26% with digitalis treatment and 74% without). Digitalis treatment was associated with decreased freedom from recurrent ventricular tachyarrhythmias (HR = 1.423; 95% CI 1.047–1.934; p = 0.023). Accordingly, digitalis treatment was associated with decreased freedom from appropriate ICD therapies (HR = 1.622; 95% CI 1.166–2.256; p = 0.004) and, moreover, higher rates of rehospitalization (38 vs. 21%; p = 0.001) and all-cause mortality (33 vs. 20%; p = 0.011). Conclusion: Among ICD recipients suffering from AF and HF, treatment with digitalis was associated with increased rates of recurrent ventricular tachyarrhythmias and ICD therapies. However, the endpoints may also have been driven by interactions between digitalis, AF, and HF.

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Section: Discussionmentioning

confidence: 99%

Digitalis Therapy and Risk of Recurrent Ventricular Tachyarrhythmias and ICD Therapies in Atrial Fibrillation and Heart Failure

et al. 2019

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“…Therefore, there is a need for improved risk stratification in VT occurrence for primary-prevention ICD indication. In previous studies, some predictors, such as prolonged QRS duration and existence of atrial fibrillation, were associated with a poor prognosis [12, 13], but whether these factors are associated with an increased risk of sudden death remains to be determined. In the present study, with the exception of serum UA, noninvasive parameters were not identified as predictors for appropriate ICD therapy for VT.…”

Section: Discussionmentioning

confidence: 99%

Association between Serum Uric Acid Level and Ventricular Tachyarrhythmia in Heart Failure Patients with Implantable Cardioverter-Defibrillator

et al. 2018

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Objectives: The uric acid (UA) level is related to cardiac events and mortality, but little is known about the clinical significance of serum UA with regard to the ventricular tachyarrhythmia (VT) risk in patients with heart failure. Methods: The present study enrolled 56 patients with ischemic and nonischemic cardiomyopathy (37 males, mean age 64.7 ± 11.1 years) who received prophylactic implantable cardioverter-defibrillator (ICD) implantation. Based on a median serum UA value, study subjects were divided into two groups: serum UA < 6.1 mg/dL (group L, n = 29) and ≥6.1 mg/dL (group H, n = 27). Echo- and electrocardiograms (QRS duration and QTc intervals) were examined in each group. Results: During the follow-up period (30 ± 8 months), 22 (39%) patients had appropriate ICD therapies for sustained VT. There was no significant difference in the electro- and echocardiographic data between both groups. However, appropriate ICD therapies were significantly higher in group H than in group L (p = 0.02). In multivariate analysis, UA was an independent predictor of appropriate ICD therapies (hazard ratio 1.826, 95% confidence interval 1.248–2.671, p = 0.002). Conclusions: Serum UA levels might be a predictor of VT, providing new aspects regarding the decision to adapt ICD implantation in patients with heart failure.

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“…Other risk factors implicated to increase the risk of appropriate shocks are diabetes, 443 , 447 elevated baseline NT-proBNP and BNP, 448 NSVT, 445 , 449 left atrial diameter, 443 , 449 and impaired renal function. 450 Data from SCD-HeFT and MADIT II trials have found a higher NYHA class, a lower LVEF, lack of use of beta-blocker therapy and single-chamber ICD as significant independent predictors for appropriate ICD shocks.…”

Section: How To Assess Risk For Adverse Outcomes In Patients With Venmentioning

confidence: 99%

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population

et al. 2020

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Usefulness of Atrial Fibrillation as a Marker for Adverse Cardiovascular Outcomes in Both Primary and Secondary Prevention in Patients With Implantable Cardioverter-Defibrillators

Cited by 6 publications

References 30 publications

Digitalis Therapy and Risk of Recurrent Ventricular Tachyarrhythmias and ICD Therapies in Atrial Fibrillation and Heart Failure

Digitalis Therapy and Risk of Recurrent Ventricular Tachyarrhythmias and ICD Therapies in Atrial Fibrillation and Heart Failure

Association between Serum Uric Acid Level and Ventricular Tachyarrhythmia in Heart Failure Patients with Implantable Cardioverter-Defibrillator

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on risk assessment in cardiac arrhythmias: use the right tool for the right outcome, in the right population

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