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Teerawongsakul P, Ananwattanasuk T, Chokesuwattanaskul R, Shah M, Lathkar-Pradhan S, Barham W, Oral H, Thakur RK, Jongnarangsin K, Tanawuttiwat T. The impact of supraventricular arrhythmias on the outcomes of guideline-compliant implantable cardioverter defibrillator programming. J Cardiovasc Electrophysiol 2024; 35:794-801. [PMID: 38384108 DOI: 10.1111/jce.16216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 10/03/2023] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Several implantable cardioverter defibrillators (ICD) programming strategies are applied to minimize ICD therapy, especially unnecessary therapies from supraventricular arrhythmias (SVA). However, it remains unknown whether these optimal programming recommendations only benefit those with SVAs or have any detrimental effects from delayed therapy on those without SVAs. This study aims to assess the impact of SVA on the outcomes of ICD programming based on 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement and 2019 focused update on optimal ICD programming and testing guidelines. METHODS Consecutive patients who underwent ICD insertion for primary prevention were classified into four groups based on SVA status and ICD programming: (1) guideline-concordant group (GC) with SVA, (2) GC without SVA, (3) nonguideline concordant group (NGC) with SVA, and (4) NGC without SVA. Cox proportional hazard models were analyzed for freedom from ICD therapies, shock, and mortality. RESULTS Seven hundred and seventy-two patients (median age, 64 years) were enrolled. ICD therapies were the most frequent in NGC with SVA (24.0%), followed by NGC without SVA (19.9%), GC without SVA (11.6%), and GC with SVA (8.1%). Guideline concordant programming was associated with 68% ICD therapy reduction (HR 0.32, p = .007) and 67% ICD shock reduction (HR 0.33, p = .030) in SVA patients and 44% ICD therapy reduction in those without SVA (HR 0.56, p = .030). CONCLUSION Programming ICDs in primary prevention patients based on current guidelines reduces therapy burden without increasing mortality in both SVA and non-SVA patients. A greater magnitude of reduced ICD therapy was found in those with supraventricular arrhythmias.
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Affiliation(s)
- Padoemwut Teerawongsakul
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Cardiovascular Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Teetouch Ananwattanasuk
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Cardiovascular Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Ronpichai Chokesuwattanaskul
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
- Department of Medicine, Cardiac Center, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Muazzum Shah
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | | | - Waseem Barham
- Cardiac Electrophysiology, Sparrow Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan, USA
| | - Hakan Oral
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Ranjan K Thakur
- Cardiac Electrophysiology, Sparrow Thoracic and Cardiovascular Institute, Michigan State University, Lansing, Michigan, USA
| | - Krit Jongnarangsin
- Cardiac Electrophysiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Tanyanan Tanawuttiwat
- Division of Cardiovascular Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Bissolino A, Andreis A, Magnano M, Budano C, Saglietto A, Angelini F, Roagna E, Mattivi S, Peyracchia M, Errigo D, Golzio PG, Castagno D, Giustetto C, De Ferrari GM. Prognostic role of left atrial enlargement in patients with implantable cardioverter defibrillators for primary prevention. Acta Cardiol 2022; 77:45-50. [PMID: 33308049 DOI: 10.1080/00015385.2020.1856491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Left atrial volume index (LAVI) is a predictor of heart failure and adverse events, irrespective of left ventricular systolic function. The role of LAVI in the prediction of appropriate implantable cardioverter-defibrillator (ICD) therapies is currently unclear and was the focus of this study. METHODS Consecutive heart failure patients with ischaemic (ICM) or idiopathic (DCM) aetiology receiving ICD for primary prevention were included. The primary endpoint was the occurrence of appropriate ICD therapies (ATs): shocks or antitachycardia pacing (ATP). Inappropriate ICD shocks were also assessed as secondary endpoint. RESULTS Among 198 included patients, severe left atrial dilatation (SLAE = LAVI ≥ 60 ml/m2) was present in 54 (27%). SLAE patients had a higher prevalence of NYHA class ≥ III, severe mitral regurgitation and atrial fibrillation history. During a median follow-up of 45 months (IQR 25-68), ATs occurred more frequently in SLAE group (33% vs. 15%, p = .007) as well as appropriate shocks (24% vs. 10%, p = .014). At multivariate analysis SLAE was an independent predictor of ATs (OR 3.19, 95% CI 1.38-7.38, p = .007). Inappropriate shocks were associated with AF during implantation (p = .03), but not with SLAE (p = .009). CONCLUSION In DCM or ICM patients candidate to receive an ICD for primary prevention, a severely enlarged left atrium is a predictive factor for ATs (shocks or ATP). The risk of inappropriate shocks was increased in patients with atrial fibrillation, rather than SLAE.
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Affiliation(s)
- Arianna Bissolino
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Alessandro Andreis
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Massimo Magnano
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Carlo Budano
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Andrea Saglietto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Filippo Angelini
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Edoardo Roagna
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Simone Mattivi
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Mattia Peyracchia
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Daniele Errigo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Pier Giorgio Golzio
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Davide Castagno
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Carla Giustetto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, Turin, Italy
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