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Elkattawy O, Malke K, Mothy D, Tran A, Elkattawy S, Rab S, Zidat A, Mohamed O, Shamoon F. Ventricular Tachycardia in Patients With Pre-eclampsia: Prevalence, Predictors, and Associated In-Hospital Adverse Events. Cureus 2024; 16:e56717. [PMID: 38646254 PMCID: PMC11032695 DOI: 10.7759/cureus.56717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction Pre-eclampsia is a pregnancy-associated multisystem disorder; in rare cases, it can be complicated by arrhythmias such as ventricular tachycardia (VT). The purpose of this study was to determine the prevalence and predictors of VT among patients admitted with pre-eclampsia as well as to analyze the independent association of VT with in-hospital outcomes in this population. Methods Data were obtained from the National Inpatient Sample from January 2016 to December 2019. Patients with a primary diagnosis of pre-eclampsia were selected using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes. Subsequently, the study population was divided into patients who developed VT versus patients who did not develop this complication. We then assessed the predictors of VT in women with pre-eclampsia as well as the independent association of VT with outcomes taking into account confounders such as age, race, and comorbidities. Results Of 255,946 patients with pre-eclampsia, 92 developed VT (0.04%) during their hospital stay. Multivariate logistic regression showed that patients with VT were far more likely to develop cardiac arrest (adjusted odds ratio, or aOR: 92.582, 95% CI: 30.958-276.871, p=0.001), require permanent pacemaker implantation (aOR: 41.866, 95% CI: 14.800-118.432, p=0.001), develop postpartum hemorrhage (aOR: 2.932, 95% CI: 1.655-5.196, p=0.001), and require left heart catheterization (aOR: 19.508, 95% CI: 3.261-116.708, p=0.001). Predictors of VT included being African American (aOR: 1.939, 95% CI: 1.183-3.177, p=0.009), cerebrovascular disease (aOR: 23.109, 95% CI: 6.953-76.802, p=0.001), congestive heart failure (aOR: 50.340, 95% CI: 28.829-87.901, p=0.001), atrial fibrillation (aOR: 20.148, 95% CI: 6.179-65.690, p=0.001), and obstructive sleep apnea, or OSA (aOR: 3.951, 95% CI: 1.486-10.505, p=0.006). Patients in the VT cohort were found to have an increased length of hospital stay compared to the non-VT cohort (7.16 vs. 4.13 days, p=0.001). Conclusion In a large cohort of women admitted with pre-eclampsia, we found the prevalence of VT to be <1%. Predictors of VT included conditions such as atrial fibrillation, congestive heart failure, and OSA and being African American. VT was found to be independently associated with several adverse outcomes as well as an increased length of hospital stay.
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Affiliation(s)
- Omar Elkattawy
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Keanaan Malke
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - David Mothy
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Aaron Tran
- Internal Medicine, Rutgers University New Jersey Medical School, Newark, USA
| | - Sherif Elkattawy
- Cardiology, St. Joseph's University Medical Center, Paterson, USA
| | - Sayeeda Rab
- Internal Medicine, Boston Medical Center, Boston, USA
| | - Ammar Zidat
- Internal Medicine, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Omar Mohamed
- Medicine, Cooperman Barnabas Medical Center, Livingston, USA
| | - Fayez Shamoon
- Cardiology, St. Joseph's University Medical Center, Paterson, USA
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Krzowski B, Kutyifa V, Vloka M, Huang DT, Attari M, Aktas M, Shah AH, Musat D, Rosenthal L, McNitt S, Polonsky B, Schuger C, Natale A, Ziv O, Beck C, Daubert JP, Goldenberg I, Zareba W. Sex-Related Differences in Ventricular Tachyarrhythmia Events in Patients With Implantable Cardioverter-Defibrillator and Prior Ventricular Tachyarrhythmias. JACC Clin Electrophysiol 2024; 10:284-294. [PMID: 38032582 DOI: 10.1016/j.jacep.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/24/2023] [Accepted: 09/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Data on the risk of ventricular tachycardia (VT), ventricular fibrillation (VF), and death by sex in patients with prior VT/VF are limited. OBJECTIVES This study aimed to assess sex-related differences in implantable cardioverter-defibrillator (ICD)-treated VT/VF events and death in patients implanted for secondary prevention or primary prevention ICD indications who experienced VT/VF before enrollment in the RAID (Ranolazine Implantable Cardioverter-Defibrillator) trial. METHODS Sex-related differences in the first and recurrent VT/VF requiring antitachycardia pacing or ICD shock and death were evaluated in 714 patients. RESULTS There were 124 women (17%) and 590 men observed during a mean follow-up of 26.81 ± 14.52 months. Compared to men, women were at a significantly lower risk of VT/VF/death (HR: 0.67; P = 0.029), VT/VF (HR: 0.68; P = 0.049), VT/VF treated with antitachycardia pacing (HR: 0.59; P = 0.019), and VT/VF treated with ICD shock (HR: 0.54; P = 0.035). The risk of recurrent VT/VF was also significantly lower in women (HR: 0.35; P < 0.001). HR for death was similar to the other endpoints (HR: 0.61; P = 0.162). In comparison to men, women presented with faster VT rates (196 ± 32 beats/min vs 177 ± 30 beats/min, respectively; P = 0.002), and faster shock-requiring VT/VF rates (258 ± 56 beats/min vs 227 ± 57 beats/min, respectively; P = 0.30). There was a significant interaction for the risk of VT/VF by race (P = 0.013) with White women having significantly lower risk than White men (HR: 0.36; P < 0.001), whereas Black women had a similar risk to Black men (HR: 1.06; P = 0.851). CONCLUSIONS Women with a history of prior VT/VF experienced a lower risk recurrent VT/VF requiring ICD therapy when compared to men. Black Women had a risk similar to men, whereas the lower risk for VT/VF in women was observed primarily in White women. (Ranolazine Implantable Cardioverter-Defibrillator Trial; NCT01215253).
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Affiliation(s)
- Bartosz Krzowski
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA; First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Valentina Kutyifa
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Margot Vloka
- Cardiology Division, Saint Alphonsus Health System, Boise, Idaho, USA
| | - David T Huang
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Mehmet Aktas
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Abrar H Shah
- Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | - Dan Musat
- Valley Health System, Ridgewood, New Jersey, USA
| | - Lawrance Rosenthal
- University of Massachusetts Memorial Health, Worcester, Massachusetts, USA
| | - Scott McNitt
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Bronislava Polonsky
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David's Medical Center, Austin, Texas, USA
| | - Ohad Ziv
- Heart and Vascular Center, Metro Health Medical Center, Cleveland, Ohio, USA
| | - Christopher Beck
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York, USA
| | | | - Ilan Goldenberg
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Wojciech Zareba
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA.
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Khan A, Huang HD. Commentary for gender and race-related disparities in the management of ventricular arrhythmias. Trends Cardiovasc Med 2023:S1050-1738(23)00105-6. [PMID: 38036080 DOI: 10.1016/j.tcm.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Asad Khan
- Department of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | - Henry D Huang
- Department of Cardiology, Rush University Medical Center, Chicago, IL, USA.
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Yoder M, Dils A, Chakrabarti A, Driesenga S, Alaka A, Ghannam M, Bogun F, Liang JJ. Gender and race-related disparities in the management of ventricular arrhythmias. Trends Cardiovasc Med 2023:S1050-1738(23)00086-5. [PMID: 37838298 DOI: 10.1016/j.tcm.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/12/2023] [Accepted: 10/08/2023] [Indexed: 10/16/2023]
Abstract
Modern studies have revealed gender and race-related disparities in the management and outcomes of cardiac arrhythmias, but few studies have focused on outcomes for ventricular arrhythmias (VAs) such as ventricular tachycardia (VT) or ventricular fibrillation (VF). The aim of this article is to review relevant studies and identify outcome differences in the management of VA among Black and female patients. We found that female patients typically present younger for VA, are more likely to have recurrent VA after catheter ablation, are less likely to be prescribed antiarrhythmic medication, and are less likely to receive primary prevention ICD placement as compared to male patients. Additionally, female patients appear to derive similar overall mortality benefit from primary prevention ICD placement as compared to male patients, but they may have an increased risk of acute post-procedural complications. We also found that Black patients presenting with VA are less likely to undergo catheter ablation, receive appropriate primary prevention ICD placement, and have significantly higher risk-adjusted 1-year mortality rates after hospital discharge as compared to White patients. Black female patients appear to have the worst outcomes out of any demographic subgroup.
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Shah MM, Chatterjee N, Liang JJ. Considerations on outcomes, patient selection, and safety of catheter ablation for ventricular arrhythmias. J Interv Card Electrophysiol 2023; 66:157-159. [PMID: 36652084 DOI: 10.1007/s10840-022-01452-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/08/2022] [Indexed: 01/19/2023]
Affiliation(s)
- Muazzum M Shah
- Section of Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI, USA
| | - Neal Chatterjee
- Electrophysiology Section, Division of Cardiology, University of Washington, WA, Seattle, USA
| | - Jackson J Liang
- Section of Electrophysiology, Division of Cardiovascular Medicine, Department of Internal Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI, USA.
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