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Allescher J, Sinnecker D, von Goeldel B, Barthel P, Müller A, Hapfelmeier A, Martens E, Laugwitz K, Schmidt G, Steger A. QRS fragmentation does not predict mortality in survivors of acute myocardial infarction. Clin Cardiol 2024; 47:e24218. [PMID: 38269630 PMCID: PMC10797824 DOI: 10.1002/clc.24218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Despite advances in coronary revascularization and in heart failure management, myocardial infarction survivors remain at substantially increased mortality risk. Precise risk assessment and risk-adapted follow-up care are crucial to improve their outcomes. Recently, the fragmented QRS complex, i.e. the presence of additional spikes within the QRS complexes on a 12-lead electrocardiogram, has been discussed as a potential non-invasive risk predictor in cardiac patients. HYPOTHESIS The aim of this study was to evaluate the prognostic meaning of the fragmented QRS complex in myocardial infarction survivors. METHODS 609 patients with narrow QRS complexes <120 ms were included in a prospective cohort study while hospitalized for myocardial infarction and followed for 5 years. RESULTS The prevalence of the fragmented QRS complex in these patients amounted to 46.8% (285 patients). These patients had no increased hazard of all-cause death (HR 0.84, 95%-CI 0.45-1.57, p = 0.582) with a mortality rate of 6.0% compared to 7.1% in patients without QRS fragmentations. Furthermore, the risks of cardiac death (HR 1.28, 95%-CI 0.49-3.31, p = 0.613) and of non-cardiac death (HR 0.6, 95%-CI 0.26-1.43, p = 0.25) were not significantly different in patients with QRS fragmentations. However, patients with QRS fragmentations had increased serum creatine kinase concentrations (1438U/l vs. 1160U/l, p = 0.039) and reduced left ventricular ejection fractions (52% vs. 54%, p = 0.011). CONCLUSIONS The hypothesis that QRS fragmentation might be a prognostic parameter in survivors of myocardial infarction was not confirmed. But those with QRS fragmentation had larger myocardial infarctions, as measured by creatine kinase and left ventricular ejection fraction.
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Affiliation(s)
- Julia Allescher
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
| | - Daniel Sinnecker
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
- DZHK (German Centre for Cardiovascular Research)Partner Site Munich Heart AllianceMunichGermany
- Medizinisches Versorgungszentrum (MVZ) HarzGoslarGermany
| | - Bernhard von Goeldel
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
| | - Petra Barthel
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
| | - Alexander Müller
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
| | - Alexander Hapfelmeier
- School of Medicine, Institute of AI and Informatics in MedicineTechnical University of MunichMunichGermany
- School of Medicine, Institute of General Practice and Health Services ResearchTechnical University of MunichMunichGermany
| | - Eimo Martens
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
| | - Karl‐Ludwig Laugwitz
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
- DZHK (German Centre for Cardiovascular Research)Partner Site Munich Heart AllianceMunichGermany
| | - Georg Schmidt
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
- DZHK (German Centre for Cardiovascular Research)Partner Site Munich Heart AllianceMunichGermany
| | - Alexander Steger
- Klinik und Poliklinik für Innere Medizin I, University HospitalTechnical University of MunichMunichGermany
- DZHK (German Centre for Cardiovascular Research)Partner Site Munich Heart AllianceMunichGermany
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Dauw J, Martens P, Nijst P, Meekers E, Deferm S, Gruwez H, Rivero-Ayerza M, Van Herendael H, Pison L, Nuyens D, Dupont M, Mullens W. The MADIT-ICD benefit score helps to select implantable cardioverter-defibrillator candidates in cardiac resynchronization therapy. Europace 2022; 24:1276-1283. [PMID: 35352116 DOI: 10.1093/europace/euac039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/05/2022] [Indexed: 01/14/2023] Open
Abstract
AIMS The aim of this study is to evaluate whether the MADIT-ICD benefit score can predict who benefits most from the addition of implantable cardioverter-defibrillator (ICD) to cardiac resynchronization therapy (CRT) in real-world patients with heart failure with reduced ejection fraction (HFrEF) and to compare this with selection according to a multidisciplinary expert centre approach. METHODS AND RESULTS Consecutive HFrEF patients who received a CRT for a guideline indication at a tertiary care hospital (Ziekenhuis Oost-Limburg, Genk, Belgium) between October 2008 and September 2016, were retrospectively evaluated. The MADIT-ICD benefit groups (low, intermediate, and high) were compared with the current multidisciplinary expert centre approach. Endpoints were (i) sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and (ii) non-arrhythmic mortality. Of the 475 included patients, 165 (34.7%) were in the lowest, 220 (46.3%) in the intermediate, and 90 (19.0%) in the highest benefit group. After a median follow-up of 34 months, VT/VF occurred in 3 (1.8%) patients in the lowest, 9 (4.1%) in the intermediate, and 13 (14.4%) in the highest benefit group (P < 0.001). Vice versa, non-arrhythmic death occurred in 32 (19.4%) in the lowest, 32 (14.6%) in the intermediate, and 3 (3.3%) in the highest benefit group (P = 0.002). The predictive power for ICD benefit was comparable between expert multidisciplinary judgement and the MADIT-ICD benefit score: Uno's C-statistic 0.69 vs. 0.69 (P = 0.936) for VT/VF and 0.62 vs. 0.60 (P = 0.790) for non-arrhythmic mortality. CONCLUSION The MADIT-ICD benefit score can identify who benefits most from CRT-D and is comparable with multidisciplinary judgement in a CRT expert centre.
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Affiliation(s)
- Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.,UHasselt, Doctoral School for Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - Petra Nijst
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - Evelyne Meekers
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.,UHasselt, Doctoral School for Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
| | - Sébastien Deferm
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.,UHasselt, Doctoral School for Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
| | - Henri Gruwez
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.,UHasselt, Doctoral School for Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
| | - Maximo Rivero-Ayerza
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - Hugo Van Herendael
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - Laurent Pison
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - Dieter Nuyens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.,UHasselt, Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, Diepenbeek, Belgium
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Salimian S, Deyell MW, Andrade JG, Chakrabarti S, Bennett MT, Krahn AD, Hawkins NM. Heart failure treatment in patients with cardiac implantable electronic devices: Opportunity for improvement. Heart Rhythm O2 2021; 2:698-709. [PMID: 34988519 PMCID: PMC8710628 DOI: 10.1016/j.hroo.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Heart failure and reduced ejection fraction (HFrEF) is the predominant indication for cardiac resynchronization therapy (CRT) and implantable cardioverter-defibrillator (ICD) implantation. The care gap and opportunity to optimize guideline-directed medical therapy (GDMT) is unclear. OBJECTIVE We sought to define uptake, eligibility, dose, and adherence to GDMT in patients with CRT/ICD and HFrEF. METHODS MEDLINE was searched from 2000 to July 2021 for major randomized trials, registries, and cohort studies evaluating GDMT in this population. Thirty-eight studies focused on medical therapy in patients with CRT/ICD devices (CRT = 23, ICD = 11, and both = 4). RESULTS In the pivotal device trials, ACEI/ARB and beta-blocker use was high (mean 94%, range 41%-99%; and 83%, range 27%-97%, respectively), but mineralocorticoid receptor antagonists were modest (mean 45%, range 32%-61%), in keeping with guidelines of that era. Similar results were found in observational registries. CRT was associated with beta-blocker uptitration, while the effects on ACEI/ARB were less consistent. For beta blockers, 57%-68% of patients were uptitrated, increasing the mean percent of target dose achieved by 24% from baseline to follow-up. In one study, adherence increased, for ACEI/ARB from 37% to 55% and beta blockers 34% to 58%. Only 1 study assessed potential eligibility at implant for sacubitril-valsartan (72%) or ivabradine (28%), and no study examined sodium-glucose cotransporter-2 inhibitors. Increased uptake, titration, and dose was associated with reduced mortality, hospitalization, and device therapies. CONCLUSION Patients with HFrEF and ICD/CRT are undertreated with respect to GDMT, and there is opportunity to optimize therapy to improve morbidity and mortality.
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Affiliation(s)
- Samaneh Salimian
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Marc W. Deyell
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Jason G. Andrade
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Santabhanu Chakrabarti
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Matthew T. Bennett
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Andrew D. Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Nathaniel M. Hawkins
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada
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Kinch Westerdahl A, Magnsjö J, Frykman V. Deactivation of implantable defibrillators at end of life - Can we do better? Int J Cardiol 2019; 291:57-62. [PMID: 30853295 DOI: 10.1016/j.ijcard.2019.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/11/2019] [Accepted: 03/01/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Dying patients with implantable defibrillators (ICD) have a risk of receiving unnecessary shocks before death. The aim of this study was to investigate if deactivation of shock therapy at end-of-life has increased since publication of new guidelines in 2010 on ICD management. METHOD AND RESULTS This is a study of two groups of ICD patients who died in hospitals before and after publication of new guidelines. Group 1 consists of 89 patients who died between 2003 and 2010. Group 2 consists of 252 patients, the total number of ICD patients in Sweden who died in hospital during 2014. Data was obtained from the Swedish ICD and Pacemaker Registry, Swedish Tax Agency and patient medical notes. Two-thirds died in wards other than Cardiology. Fifty-four percent in group 1 had a Do-Not-Resuscitate-order (DNR) compared to 73% in group 2. Shock deactivation was present in 52% in group 1 and 67% in group 2. The difference in shock deactivation between group 1 and 2 was only significant (p = 0.014) for DNR-patients treated in Cardiology. A significant difference (p = 0.036) was found in deactivation within group 2 between DNR-patients in Cardiology vs. DNR-patients in Non-Cardiology wards. CONCLUSION Two-thirds of ICD patients die in wards other than Cardiology. Since publication of guidelines on ICD management there is a general increase in shock deactivation for DNR-patients, but only significant for patients in Cardiology. This implicate that actions have to be taken for patients treated in Non-Cardiology wards to bridge the gap between guidelines recommendations and clinical practice.
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Affiliation(s)
| | - Jackline Magnsjö
- Department of Clinical Sciences, Karolinska Institutet, Danderyds Hospital, Sweden
| | - Viveka Frykman
- Department of Clinical Sciences, Karolinska Institutet, Danderyds Hospital, Sweden
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5
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Platonov PG, Holmqvist F. Registry data on implantation of ICD is not necessarily reflective of an arrhythmic event. Am Heart J 2019; 212:158-159. [PMID: 30992123 DOI: 10.1016/j.ahj.2019.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, 22185 Lund, Sweden.
| | - Fredrik Holmqvist
- Department of Cardiology, Clinical Sciences, Lund University, 22185 Lund, Sweden
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Garcia R, Degand B, Fraty M, Le Marcis V, Bidegain N, Laude D, Tavernier M, Le Gal F, Hadjadj S, Saulnier PJ, Ragot S. Baroreflex sensitivity assessed with the sequence method is associated with ventricular arrhythmias in patients implanted with a defibrillator for the primary prevention of sudden cardiac death. Arch Cardiovasc Dis 2019; 112:270-277. [PMID: 30670362 DOI: 10.1016/j.acvd.2018.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/10/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Left ventricular ejection fraction lacks accuracy in predicting sudden cardiac death, resulting in unnecessary implantation of cardioverter defibrillators for the primary prevention of sudden cardiac death. Baroreflex sensitivity could help to stratify patients at risk of ventricular arrhythmia. AIM To assess the association between cardiac baroreflex sensitivity and ventricular arrhythmias in patients implanted with an implantable cardioverter defibrillator for the primary prevention of sudden cardiac death after myocardial infarction. METHODS This case-control single-centre study took place between 2015 and 2016. Cases (n=10) had experienced ventricular arrhythmias treated by the implantable cardioverter defibrillator in the previous 3 years; controls (n=22) had no arrhythmia during the same period. Baroreflex sensitivity was assessed using the temporal sequence method (mean slope) and cross-spectral analysis (low-frequency gain and high-frequency gain). RESULTS The mean age was 65 years; 94% of the patients were men. 24-hour Holter electrocardiogram autonomous nervous system variables, left ventricular ejection fraction and N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) concentration did not differ between cases and controls. The mean slope was lower in cases than in controls (8 vs. 15ms/mmHg [P=0.009] in the supine position; 7 vs. 12ms/mmHg [P=0.038] in the standing position). The mean slope in the supine position was still significantly different between groups after adjustment for age, left ventricular ejection fraction and NT-proBNP (P=0.03). By comparison, low-frequency gain and high-frequency gain did not differ between groups in either the supine or the standing position. CONCLUSION Patients with ventricular arrhythmias had a lower mean slope compared with those who were free of arrhythmia. A prospective study is needed to confirm this association.
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Affiliation(s)
- Rodrigue Garcia
- Service de cardiologie, CHU Poitiers, 86021 Poitiers, France; Faculté de médecine et pharmacie, université Poitiers, 86021 Poitiers, France.
| | - Bruno Degand
- Service de cardiologie, CHU Poitiers, 86021 Poitiers, France
| | - Mathilde Fraty
- Service d'endocrinologie, CHU Poitiers, 86021 Poitiers, France; Faculté de médecine et pharmacie, université Poitiers, 86021 Poitiers, France
| | | | | | - Dominique Laude
- UMRS 1138, Inserm, Centre de recherche des Cordeliers, Sorbonne université, Sorbonne Paris Cité, 75006 Paris, France
| | | | - François Le Gal
- Service de cardiologie, CHU Poitiers, 86021 Poitiers, France
| | - Samy Hadjadj
- Service d'endocrinologie, CHU Poitiers, 86021 Poitiers, France; Faculté de médecine et pharmacie, université Poitiers, 86021 Poitiers, France; CHU Poitiers, CIC 1402, 86021 Poitiers, France
| | - Pierre-Jean Saulnier
- CHU Poitiers, CIC 1402, 86021 Poitiers, France; Faculté de médecine et pharmacie, université Poitiers, 86021 Poitiers, France
| | - Stéphanie Ragot
- CHU Poitiers, CIC 1402, 86021 Poitiers, France; Faculté de médecine et pharmacie, université Poitiers, 86021 Poitiers, France
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Weng W, Sapp J, Doucette S, MacIntyre C, Gray C, Gardner M, Abdelwahab A, Parkash R. Benefit of Implantable Cardioverter-Defibrillator Generator Replacement in a Primary Prevention Population-Based Cohort. JACC Clin Electrophysiol 2017; 3:1180-1189. [DOI: 10.1016/j.jacep.2017.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 02/15/2017] [Accepted: 03/13/2017] [Indexed: 11/25/2022]
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Hawkins NM, Grubisic M, Andrade JG, Huang F, Ding L, Gao M, Bashir J. Long-term complications, reoperations and survival following cardioverter-defibrillator implant. Heart 2017; 104:237-243. [PMID: 28747313 DOI: 10.1136/heartjnl-2017-311638] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/26/2017] [Accepted: 06/28/2017] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Implantable cardioverter-defibrillators (ICDs) reduce risk of death in select populations, but are also associated with harms. We aimed to characterise long-term complications and reoperation rate. METHODS We assessed the rate, cumulative incidence and predictors of long-term reoperation and survival using a prospective, multicentre registry serving British Columbia in Canada, a universal single payer healthcare system with 4.5 million residents. 3410 patients (mean 63.3 years, 81.7% male) with new primary (n=1854) or secondary prevention (n=1556) ICD implant from 2003 to 2012 were followed for a median of 34 months (single chamber n=1069, dual chamber n=1905, biventricular n=436). Independent predictors of adverse outcomes were defined using Cox regression models. RESULTS The overall reoperation rate was 12.0% per patient-year, and less for single vs dual vs biventricular ICDs (9.1% vs 12.5% vs 17.8% per patient-year, respectively). The Kaplan-Meier complication estimates (excluding generator end of life) at 1, 3 and 5 years were respectively: single chamber 10.2%, 16.2% and 21.6%; dual 11.7%, 19.1% and 27.4% and biventricular 15.9%, 22.2% and 24.7%. Cardiac resynchronisation therapy had the highest rate of early lead complications, but lower long-term need for upgrade. Device complexity, age and atrial fibrillation were key determinants of complications. Overall mortality at 1, 3 and 5 years was 5.4%, 17.4% and 32.7%, respectively. In younger patients, observed 5-year survival approached the expected survival in the general population (relative survival ratio=0.96 (0.90-0.98)). With increasing age, observed survival steadily declined relative to expected. CONCLUSIONS In a prospective registry capturing all procedures, complication and reoperation rates following de novo ICD implantation were high. Shared decision making must carefully consider these factors.
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Affiliation(s)
| | - Maja Grubisic
- BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - Jason G Andrade
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Flora Huang
- University of British Columbia, Vancouver, Canada
| | - Lillian Ding
- Cardiac Services of British Columbia, Vancouver, Canada
| | - Min Gao
- BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - Jamil Bashir
- Division of Cardiovascular Surgery, University of British Columbia, Vancouver, Canada
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Sjöblom J, Borgquist R, Gadler F, Kalm T, Ljung L, Rosenqvist M, Frykman V, Platonov PG. Clinical risk profile score predicts all cause mortality but not implantable cardioverter defibrillator intervention rate in a large unselected cohort of patients with congestive heart failure. Ann Noninvasive Electrocardiol 2017; 22. [PMID: 27800644 DOI: 10.1111/anec.12414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/28/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Primary prophylactic implantable cardioverter defibrillator (ICD) therapy is indicated for patients with reduced left ventricular ejection fraction (LVEF). We aimed to determine if preoperative clinical risk profiling can predict long-term benefit, and if clinical risk scores can be applied and improved in a patient cohort outside the clinical trial setting. METHODS Using registry data, 789 patients with reduced LVEF who received ICDs for primary prevention during 2006-2011 were identified (age 64 ± 11 years, 82% men, 63% ischemic etiology, 52% cardiac resynchronization therapy with defibrillator). The patients were divided into three risk groups, based on the presence of baseline clinical risk factors (age >70, QRS duration >120 ms, New York Heart Association class III-IV, atrial fibrillation history, or creatinine >106 μmol/L). Endpoints were all-cause mortality and survival free of adequate ICD therapy. RESULTS Mean follow-up was 39 ± 18 months. Annual mortality was 7.6%, and increased with risk group (p < .001). Rates of appropriate antitachycardia pacing and shock therapy were not statistically different between the groups, and ranged from 11%-16% and 6%-14%, respectively. By combining the previous risk score with data on diabetes, a better independent prediction of mortality was achieved; mortality rates then ranged from 11% (low-risk) to 46% (high-risk) (p < .0001). CONCLUSIONS Implantable cardioverter defibrillator therapies occur across the spectrum of comorbidities in a population with systolic heart failure. However, all-cause mortality is considerably higher in the group of patients with accumulated risk factors, and using the proposed scoring system can be helpful for the evaluation and risk stratification of the patient prior to making a decision for a primary prophylactic ICD implantation.
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Affiliation(s)
- Johanna Sjöblom
- Department of Cardiology, Danderyd General Hospital, Danderyd, Sweden
| | - Rasmus Borgquist
- Arrhythmia Clinic, Skåne University Hospital and Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Fredrik Gadler
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Torbjörn Kalm
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Lina Ljung
- Section of Cardiology, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| | - Mårten Rosenqvist
- Department of Cardiology, Danderyd General Hospital, Danderyd, Sweden
| | - Viveka Frykman
- Department of Cardiology, Danderyd General Hospital, Danderyd, Sweden
| | - Pyotr G Platonov
- Arrhythmia Clinic, Skåne University Hospital and Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
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Uhm JS, Kim TH, Kim IC, Park YA, Shin DG, Lim YM, Yu HT, Yang PS, Pak HN, Kang SM, Lee MH, Joung B. Long-Term Prognosis of Patients with an Implantable Cardioverter-Defibrillator in Korea. Yonsei Med J 2017; 58:514-520. [PMID: 28332355 PMCID: PMC5368135 DOI: 10.3349/ymj.2017.58.3.514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/09/2017] [Accepted: 01/10/2017] [Indexed: 01/06/2023] Open
Abstract
PURPOSE The objective of this study was to elucidate the long-term prognosis of patients with implantable cardioverter-defibrillators (ICDs) in Korea. MATERIALS AND METHODS We enrolled 405 patients (age, 57.7±16.7 years; 311 men) who had undergone ICD implantation. The patients were divided into three groups: heart failure (HF) and ICD for primary (group 1, n=118) and secondary prevention (group 2, n=93) and non-HF (group 3, n=194). We compared appropriate and inappropriate ICD therapy delivery among the groups and between high- (heart rate ≥200 /min) and low-rate (<200 /min) ICD therapy zones. RESULTS During the follow-up period (58.9±49.8 months), the annual appropriate ICD therapy rate was higher in group 2 (10.4%) than in groups 1 and 3 (6.1% and 5.9%, respectively, p<0.001). There were no significant differences in annual inappropriate ICD therapy rate among the three groups. In group 1, the annual appropriate ICD therapy rate was significantly lower in patients with a high-rate versus a low-rate therapy zone (4.5% and 9.6%, respectively, p=0.026). In group 3, the annual inappropriate ICD therapy rate was significantly lower in patients with a high-rate versus a low-rate therapy zone (3.1% and 4.0%, respectively, p=0.048). CONCLUSION Appropriate ICD therapy rates are not low in Korean patients with ICD, relative to prior large-scale studies in Western countries. Appropriate and inappropriate ICD therapy could be reduced by a high-rate therapy zone in patients with HF and ICD for primary prevention, as well as non-HF patients, respectively.
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Affiliation(s)
- Jae Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - In Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ah Park
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Geum Shin
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yeong Min Lim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Pil Sung Yang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hui Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Min Kang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moon Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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