1
|
Steinberg C, Dognin N, Sodhi A, Champagne C, Staples JA, Champagne J, Laksman ZW, Sarrazin JF, Bennett MT, Plourde B, Deyell MW, Andrade JG, Roy K, Yeung-Lai-Wah JA, Hawkins NM, Mondésert B, Blier L, Nault I, O'Hara G, Krahn AD, Philippon F, Chakrabarti S. DREAM-ICD-II Study. Circulation 2022; 145:742-753. [PMID: 34913361 DOI: 10.1161/circulationaha.121.056471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Regulatory authorities of most industrialized countries recommend 6 months of private driving restriction after implantation of a secondary prevention implantable cardioverter-defibrillator (ICD). These driving restrictions result in significant inconvenience and social implications. This study aimed to assess the incidence rate of appropriate device therapies in contemporary recipients of a secondary prevention ICD. METHODS This retrospective study at 3 Canadian tertiary care centers enrolled consecutive patients with new secondary prevention ICD implants between 2016 and 2020. RESULTS For a median of 760 days (324, 1190 days), 721 patients were followed up. The risk of recurrent ventricular arrhythmia was highest during the first 3 months after device insertion (34.4%) and decreased over time (10.6% between 3 and 6 months, 11.7% between 6 and 12 months). The corresponding incidence rate per 100 patient-days was 0.48 (95% CI, 0.35-0.64) at 90 days, 0.28 (95% CI, 0.17-0.45) at 180 days, and 0.21 (95% CI, 0.13-0.33) between 181 and 365 days after ICD insertion (P<0.001). The cumulative incidence of arrhythmic syncope resulting in sudden cardiac incapacitation was 1.8% within the first 90 days and subsequently dropped to 0.4% between 91 and 180 days (P<0.001) after ICD insertion. CONCLUSIONS The incidence rate of appropriate therapies resulting in sudden cardiac incapacitation in contemporary recipients of a secondary prevention ICD is much lower than previously reported and declines significantly after the first 3 months. Lowering driving restrictions to 3 months after the index cardiac event seems safe, and revision of existing guidelines should be considered in countries still adhering to a 6-month period. Existing restrictions for private driving after implantation of a secondary prevention ICD should be reconsidered.
Collapse
Affiliation(s)
- Christian Steinberg
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Nicolas Dognin
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Amit Sodhi
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
| | - Catherine Champagne
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - John A Staples
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada (J.A.S.)
| | - Jean Champagne
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Zachary W Laksman
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
| | - Jean-François Sarrazin
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Matthew T Bennett
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
| | - Benoit Plourde
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Marc W Deyell
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
| | - Jason G Andrade
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada (J.G.A., B.M.)
| | - Karine Roy
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - John A Yeung-Lai-Wah
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
| | - Nathaniel M Hawkins
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
| | - Blandine Mondésert
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada (J.G.A., B.M.)
| | - Louis Blier
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Isabelle Nault
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Gilles O'Hara
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Andrew D Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
| | - François Philippon
- Institut universitaire de cardiologie et pneumologie de Québec, Quebec, Canada (C.S., N.D., C.C., J.C., J.-F.S., B.P., K.R., L.B., I.N., G.O., F.P.)
| | - Santabhanu Chakrabarti
- Centre for Cardiovascular Innovation, Division of Cardiology (A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.-W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
- Department of Medicine (A.S., J.A.S., Z.L., M.B., M.W.D., J.G.A., J.A.Y.-L.W., N.M.H., A.D.K., S.C.), University of British Columbia, Vancouver, Canada
| |
Collapse
|
2
|
Søholm H, Laursen ML, Kjaergaard J, Lindhardt TB, Hassager C, Møller JE, Gregers E, Linde L, Johansen JB, Winther-Jensen M, Lippert FK, Køber L, Philbert BT. Early ICD implantation in cardiac arrest survivors with acute coronary syndrome - predictors of implantation, ICD-therapy and long-term survival. SCAND CARDIOVASC J 2021; 55:205-212. [PMID: 33749460 DOI: 10.1080/14017431.2021.1900597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives. Implantable cardioverter defibrillator (ICD) implantation in patients resuscitated from out-of-hospital cardiac arrest (OHCA) due to acute myocardial infarction (AMI) is controversial. Design. Consecutive OHCA-survivors due to AMI from two Danish tertiary heart centers from 2007 to 2011 were included. Predictors of ICD-implantation, ICD-therapy and long-term survival (5 years) were investigated. Patients with and without ICD-implantation during the index hospital admission were included (later described as early ICD-implantation). Patients with an ICD after hospital discharge were censored from further analyses at time of implantation. Results. We identified 1,457 consecutive OHCA-patients, and 292 (20%) of the cohort met the inclusion criteria. An ICD was implanted during hospital admission in 78 patients (27%). STEMI and successful revascularization were inversely and independently associated with ICD-implantation (ORSTEMI = 0.37, 95% CI: 0.14-0.94, ORrevasc = 0.11, 0.03-0.36) whereas age, sex, LVEF <35%, comorbidity burden or shockable first OHCA-rhythm were not associated with ICD-implantation. Appropriate ICD-shock therapy during the follow-up period was noted in 15% of patients (n = 12). Five-year mortality-rate was significantly lower in ICD-patients (18% vs. 28%, plogrank = 0.02), which was persistent after adjustment for prognostic factors (HR = 0.44 (95% CI: 0.23-0.88)). This association was no longer found when using first event (death or appropriate shock whatever came first) as outcome variable (plogrank = 0.9). Conclusions. Mortality after OHCA due to AMI was significantly lower in patients with early ICD-implantation after adjustment for prognostic factors. When using appropriate shock and death as events, ICD-patients had similar outcome as patients without an ICD, which may suggest a survival benefit due to appropriate device therapy.
Collapse
Affiliation(s)
- Helle Søholm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Marie L Laursen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Tommi B Lindhardt
- Department of Cardiology, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob E Møller
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Emilie Gregers
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Louise Linde
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jens B Johansen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Matilde Winther-Jensen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Epidemiology, Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Freddy K Lippert
- Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Berit T Philbert
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
3
|
Peyracchia M, Errigo D, Raposeiras Rubin S, Conrotto F, DiNicolantonio JJ, Omedè P, Rettegno S, Iannaccone M, Moretti C, D'Amico M, Gaita F, D'Ascenzo F. Beta-blocker therapy reduces mortality in patients with coronary artery disease treated with percutaneous revascularization: a meta-analysis of adjusted results. J Cardiovasc Med (Hagerstown) 2019; 19:337-343. [PMID: 29877974 DOI: 10.2459/jcm.0000000000000662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIMS The long-term impact of beta blockers on prognosis in patients treated with contemporary therapies for coronary artery disease remains to be defined. METHODS AND RESULTS All observational studies evaluating the impact of beta blockers in patients treated with coronary revascularization and contemporary therapies and adjusted with multivariate analysis were included. All-cause death was the primary endpoint, while Major Adverse Cardiac Events (MACE) (composite endpoint of all-cause death or myocardial infarction, MI) and MI were secondary endpoints. A total of 26 studies were included, with 863 335 patients. After 3 (1-4.3) years, long-term risk of all-cause death was lower in patients on beta blockers [odds ratio, OR 0.69 (0.66-0.72)], both for Acute Coronary Syndrome (ACS) [OR 0.60 (0.56-0.65)], and stable angina patients [OR 0.84 (0.78-0.91)], independently from ejection fraction [OR 0.64 (0.42-0.98) for reduced ejection fraction and OR 0.79 (0.69-0.91) for preserved ejection fraction]. The risk of long-term MACE was lower but NS for ACS patients treated with beta blockers [OR 0.83 (0.69-1.00)], as in stable angina. Similarly, risk of MI did not differ between patients treated with beta blockers or without beta blockers [OR 0.99 (0.89-1.09), all 95% confidence intervals]. Using meta-regression analysis, the benefit of beta blockers was increased for those with longer follow-up. The number needed to treat was 52 to avoid one event of all-cause death for ACS patients and 111 for stable patients. CONCLUSION Even in percutaneous coronary intervention era, beta blockers reduce mortality in patients with coronary artery disease, confirming their protective effect, which was consistent for both ACS and stable patients indifferently of preserved or reduced ejection fraction.
Collapse
Affiliation(s)
- Mattia Peyracchia
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | - Daniele Errigo
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | - Sergio Raposeiras Rubin
- Department of Cardiology and Coronary Care Unit, Hospital Clínico Universitario de Santiago de Compostela, A Coruña, Spain
| | - Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | | | - Pierluigi Omedè
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | - Sara Rettegno
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | - Mario Iannaccone
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | - Claudio Moretti
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città Della Salute e della Scienza, Turin, Italy
| |
Collapse
|
4
|
Abstract
PURPOSE OF REVIEW Sudden cardiac death (SCD) accounts for an estimated 310 000 deaths in the United States each year. Implantable cardioverter defibrillator (ICD) implantation has revolutionized SCD prevention in heart failure patients, but only a minority of patients with ICDs receive appropriate therapy for ventricular arrhythmias. At present, the selection of patients for ICD is based largely on left ventricular ejection fraction and heart failure, but further risk stratification is still needed to determine which patients will derive the greatest benefit. RECENT FINDINGS Multicenter studies have failed to confirm the utility of microvolt T-wave alternans to predict ventricular arrhythmias in patients with ICDs. Additional risk stratification tools including resting ECG characteristics, nonsustained ventricular tachycardia, tests of autonomic function, and cardiac MRI demonstrate predictive value but have limited clinical applicability at present. SUMMARY Depressed ejection fraction with symptomatic heart failure remains the most powerful predictor of SCD and is the primary method currently used in patient care decisions. Progress continues in evaluation of additional risk factors and risk stratification tools, but no one test or combination of tests is definitive for prediction of arrhythmic events.
Collapse
|
5
|
Le Heuzey JY, Marijon E, Lavergne T, Otmani A. Management of ventricular and atrial arrhythmias in humans: towards a patient-specific approach. Europace 2012; 14 Suppl 5:v125-v128. [DOI: 10.1093/europace/eus283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
|
6
|
Bisht GS, Holmberg S, Kulinsky L, Madou M. Diffusion-free mediator based miniature biofuel cell anode fabricated on a carbon-MEMS electrode. LANGMUIR : THE ACS JOURNAL OF SURFACES AND COLLOIDS 2012; 28:14055-14064. [PMID: 22946444 DOI: 10.1021/la302708h] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We report on the functionalization of a micropatterned carbon electrode fabricated using the carbon-MEMS process for its use as a miniature diffusion-free glucose oxidase anode. Carbon-MEMS based electrodes offer precise manufacturing control on both the micro- and nanoscale and possess higher electron conductivity than redox hydrogels. However, the process involves pyrolysis in a reducing environment that renders the electrode surface less reactive and introduction of a high density of functional groups becomes challenging. Our functionalization strategy involves the electrochemical oxidation of amine linkers onto the electrode. This strategy works well with both aliphatic and aryl linkers and uses stable compounds. The anode is designed to operate through mediated electron transfer between 2,5-dihydroxybenzaldehyde (DHB) based redox mediator and glucose oxidase enzyme. The electrode was first functionalized with ethylene diamine (EDA) to serve as a linker for the redox mediator. The redox mediator was then grafted through reductive amination, and attachment was confirmed through cyclic voltammetry. The enzyme immobilization was carried out through either adsorption or attachment, and their efficiency was compared. For enzyme attachment, the DHB attached electrode was functionalized again through electro-oxidation of aminobenzoic acid (ABA) linker. The ABA functionalization resulted in reduction of the DHB redox current, perhaps due to increased steric hindrance on the electrode surface, but the mediator function was preserved. Enzyme attachment was then carried out through a coupling reaction between the free carboxyl group on the ABA linker and the amine side chains on the enzyme. The enzyme incubation for both adsorption and attachment was done either through a dry spotting method or wet spotting method. The dry spotting method calls for the evaporation of enzyme droplet to form a thin film before sealing the electrode environment, to increase the effective concentration of the enzyme on the electrode surface during incubation. The electrodes were finally protected with a gelatin based hydrogel film. The anode half-cell was tested using cyclic voltammetry in deoxygenated phosphate buffer saline solution pH 7.4 to minimize oxygen interference and to simulate the pH environment of the body. The electrodes that yielded the highest anodic current were prepared by enzyme attachment method with dry spotting incubation. A polarization response was generated for this anodic half-cell and exhibits operation close to maximum efficiency that is limited by the mass transport of glucose to the electrode.
Collapse
Affiliation(s)
- Gobind S Bisht
- Department of Biomedical Engineering, University of California, Irvine, California 92617, United States
| | | | | | | |
Collapse
|
7
|
Nombela-Franco L, Mitroi CD, Fernández-Lozano I, García-Touchard A, Toquero J, Castro-Urda V, Fernández-Diaz JA, Perez-Pereira E, Beltrán-Correas P, Segovia J, Werner GS, Javier G, Luis AP. Ventricular Arrhythmias Among Implantable Cardioverter-Defibrillator Recipients for Primary Prevention. Circ Arrhythm Electrophysiol 2012; 5:147-54. [PMID: 22205684 DOI: 10.1161/circep.111.968008] [Citation(s) in RCA: 115] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
An implantable cardioverter-defibrillator (ICD) is the therapy of choice for primary prevention in patients with ischemia who are at risk for sudden cardiac death (SCD). One third of patients with significant coronary disease have chronic total coronary occlusion (CTO), which is associated with long-term mortality in patients with previous myocardial infarction. However, the impact of CTO on the occurrence of ventricular arrhythmias and long-term mortality in ICD recipients remains unknown.
Methods and Results—
All consecutive patients with coronary artery disease receiving ICD therapy for the prevention of SCD were included in the study. Among other characteristics, the existence of CTO was assessed. During follow-up, the occurrence of appropriate device delivery because of ventricular arrhythmias as well as mortality were noted. A total of 162 patients (mean age, 62±9 years; 93% men) with an ICD were included and followed for a median of 26 months (interquartile range, 12–42). At least 1 CTO was present in 71 (44%) patients. Appropriate device therapy was detected in 18% of the patients during the follow-up. The presence of CTO was associated with higher ventricular arrhythmia and mortality rates (log-rank test, <0.01). Multivariable analysis revealed that CTO was independently associated with appropriate ICD intervention (hazard ratio, 3.5;
P
=0.003).
Conclusions—
In patients with ischemic heart disease receiving ICDs for primary prevention of SCD, CTO is an independent predictor for the occurrence of ventricular arrhythmias and has an adverse impact on long-term mortality.
Collapse
Affiliation(s)
- Luis Nombela-Franco
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Cristina D. Mitroi
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Ignacio Fernández-Lozano
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Arturo García-Touchard
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Jorge Toquero
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Victor Castro-Urda
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Jose A. Fernández-Diaz
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Elena Perez-Pereira
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Paula Beltrán-Correas
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Javier Segovia
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Gerald S. Werner
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Goicolea Javier
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| | - Alonso-Pulpón Luis
- From the Department of Cardiology, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain (L.N.-F., C.D.M., I.F.-L., A.G.-T., J.T., V.C.-U., J.A.F.-D., E.P.-P., P.B.-C., J.S., J.G., L.A.-P.); and Department of Internal Medicine I, Klinikum Darmstadt, Darmstadt, Germany (G.S.W.)
| |
Collapse
|
8
|
Genome-wide association of implantable cardioverter-defibrillator activation with life-threatening arrhythmias. PLoS One 2012; 7:e25387. [PMID: 22247754 PMCID: PMC3256134 DOI: 10.1371/journal.pone.0025387] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 09/02/2011] [Indexed: 11/19/2022] Open
Abstract
Objectives To identify genetic factors that would be predictive of individuals who require an implantable cardioverter-defibrillator (ICD), we conducted a genome-wide association study among individuals with an ICD who experienced a life-threatening arrhythmia (LTA; cases) vs. those who did not over at least a 3-year period (controls). Background Most individuals that receive implantable cardioverter-defibrillators never experience a life-threatening arrhythmia. Genetic factors may help identify who is most at risk. Methods Patients with an ICD and extended follow-up were recruited from 34 clinical sites with the goal of oversampling those who had experienced LTA, with a cumulative 607 cases and 297 controls included in the analysis. A total of 1,006 Caucasian patients were enrolled during a time period of 13 months. Arrhythmia status of 904 patients could be confirmed and their genomic data were included in the analysis. In this cohort, there were 704 males, 200 females, and the average age was 73.3 years. We genotyped DNA samples using the Illumina Human660 W Genotyping BeadChip and tested for association between genotype at common variants and the phenotype of having an LTA. Results and Conclusions We did not find any associations reaching genome-wide significance, with the strongest association at chromosome 13, rs11856574 at P = 5×10−6. Loci previously implicated in phenotypes such as QT interval (measure of the time between the start of the Q wave and the end of the T wave as measured by electrocardiogram) were not found to be significantly associated with having an LTA. Although powered to detect such associations, we did not find common genetic variants of large effect associated with having a LTA in those of European descent. This indicates that common gene variants cannot be used at this time to guide ICD risk-stratification. Trial Registration ClinicalTrials.gov NCT00664807
Collapse
|
9
|
Sudden cardiac death risk stratification and assessment: primary prevention based on ejection fraction criteria. Heart Fail Clin 2011; 7:175-83, vii. [PMID: 21439496 DOI: 10.1016/j.hfc.2010.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sudden cardiac death (SCD) is the prime cause of death in the United States. The trials that focus on identifying and protecting patients at risk of SCD have identified the left ventricular ejection fraction (EF) as the single clinical marker that is most useful for risk assessment and stratification in primary prevention. This article reviews the data from major randomized clinical trials of implantable cardioverter-defibrillator implantation in patients with low EF for the primary prevention of SCD and exposes some of the shortcomings of the EF as a stratifier of mortality risk.
Collapse
|
10
|
Tereshchenko LG, Ghanem RN, Abeyratne A, Swerdlow CD. Intracardiac QT integral on far-field ICD electrogram predicts sustained ventricular tachyarrhythmias in ICD patients. Heart Rhythm 2011; 8:1889-94. [PMID: 21802390 DOI: 10.1016/j.hrthm.2011.07.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 07/23/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Prediction of sustained ventricular tachycardia (VT)/ventricular fibrillation (VF) could help to guide preventive interventions in at-risk patients. The QRST integral (∫QT) reflects intrinsic repolarization properties. OBJECTIVE The objective of this study was to determine whether intracardiac ∫QT predicts VT/VF in the next few months in patients with implantable cardioverter defibrillators (ICDs). METHODS Far-field (FF) and near-field (NF) right ventricular intracardiac electrograms (EGMs) were recorded via telemetry in 46 patients with structural heart disease and ICDs implanted for secondary prevention of sudden cardiac death. Epochs of 4.9 ± 0.4 minutes during sinus rhythm (mean heart rate 70.9 ± 15.2 beats/min) and ventricular pacing at 105 beats/min were analyzed. Mean ∫QT was calculated on FF and NF EGMs as the algebraic sum of areas under the QRST curve and adjusted by mean heart rate. Patients were followed up for at least 3 months. True VT/VF events treated by the ICD served as the end point. RESULTS During a mean follow-up of 4.6 months, 22 patients (48%) were treated for VT/VF. Unadjusted and adjusted by heart rate, FF EGM ∫QT in sinus rhythm was a significant predictor of VT/VF (unadjusted ∫QT hazard ratio 1.007; 95% confidence interval 1.002 to 1.0013; P = .007; adjusted ∫QT hazard ratio 1.68; 95% confidence interval 1.19 to 2.36; P = .002). The highest quartile of intracardiac ∫QT predicted VT/VF (log-rank test P = .042) and identified patients at risk with a specificity of 86% and positive predictive value of 73%. CONCLUSION Increased intracardiac FF EGM ∫QT predicts VT/VF in patients with structural heart disease and secondary prevention ICDs.
Collapse
Affiliation(s)
- Larisa G Tereshchenko
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA.
| | | | | | | |
Collapse
|
11
|
Current World Literature. Curr Opin Support Palliat Care 2010; 4:293-304. [DOI: 10.1097/spc.0b013e328340e983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
12
|
Marijon E, Trinquart L, Otmani A, Leclercq C, Fauchier L, Chevalier P, Klug D, Defaye P, Lellouche N, Mansourati J, Deharo JC, Sadoul N, Anselme F, Maury P, Davy JM, Extramiana F, Hidden-Lucet F, Probst V, Bordachar P, Mansour H, Chauvin M, Jouven X, Lavergne T, Chatellier G, Le Heuzey JY. Predictors for short-term progressive heart failure death in New York Heart Association II patients implanted with a cardioverter defibrillator--the EVADEF study. Am Heart J 2010; 159:659-664.e1. [PMID: 20362726 DOI: 10.1016/j.ahj.2010.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Accepted: 01/14/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Sudden cardiac death (SCD) is the predominant cause of mortality in patients with mild heart failure (HF). This 2-year follow-up, multicenter, cohort study aimed to assess the extent to which implantable cardioverter defibrillators (ICDs), by reducing SCD, lead to predominant progressive HF death in mildly symptomatic HF patients at baseline in daily medical practice. METHODS Between June 2001 and June 2003, 1,030 New York Heart Association II patients received an ICD in 22 French centers. Sudden cardiac death and progressive HF mortality rates were assessed using competing risk methodology, and predictors for progressive HF at baseline were tested in a multivariate regression model. RESULTS During a mean follow-up of 22 +/- 6 months, 114 deaths occurred: 12 (10.5%) due to SCD and 52 (45.6%) due to progressive HF (24-month cause-specific mortality rates of 1.2% [95% CI 0.6-1.9] and 5.4% [95% CI 4.0-6.8], respectively). Diuretics use (hazard ratio [HR] 2.8, 95% CI 1.5-5.5, P = .002), history of atrial fibrillation (HR 2.09, 95% CI 1.2-3.65, P = .01), and low ejection fraction (HR 2.7, 95% CI 1.4-4.8, P = .0008) were independent predictors for progressive HF death, whereas beta-blocker therapy was a protector (HR 0.6, 95% CI 0.3-0.9, P = .04). Half of the patients (48%) who died from progressive HF within 2 years of ICD implant initially presented with enlarged QRS (> or =120 milliseconds). CONCLUSIONS Because of ICD efficiency, progressive HF is the main cause of death within 2 years of implant, although these patients are only mildly symptomatic at implantation. In addition to optimal pharmacologic therapy, these results raise the question of systematically implanting ICDs with cardiac resynchronization therapy in patients with electrical asynchronism at baseline.
Collapse
|
13
|
Van Herendael H, Pinter A, Ahmad K, Korley V, Mangat I, Dorian P. Role of antiarrhythmic drugs in patients with implantable cardioverter defibrillators. Europace 2010; 12:618-25. [DOI: 10.1093/europace/euq073] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|