Effect of ICD Therapies on Mortality in the OMNI Trial.

Autor: Sun S; UT Southwestern Medical Center, Dallas, Texas, USA., Johnson J; Medtronic Inc, Minneapolis, Minnesota, USA., Degroot P; Medtronic Inc, Minneapolis, Minnesota, USA., Brown ML; Medtronic Inc, Minneapolis, Minnesota, USA., Obel O; UT Southwestern Medical Center, Dallas, Texas, USA.; VA North Texas Health Care System, Dallas, Texas, USA.
Jazyk: angličtina
Zdroj: Journal of cardiovascular electrophysiology [J Cardiovasc Electrophysiol] 2016 Feb; Vol. 27 (2), pp. 192-9. Date of Electronic Publication: 2015 Dec 11.
DOI: 10.1111/jce.12860
Abstrakt: Background: Analyses from primary prevention trials on implantable cardioverter defibrillator (ICD) therapy have shown an association between shocks and increased mortality. Recent data suggest a similar association with antitachycardia pacing (ATP).
Objective: The OMNI study is an observational study of pacemaker and ICD use. We aim to examine associations between ICD therapies and mortality in this setting.
Methods: A total of 2,255 OMNI patients with ICDs were included. Treated episodes were classified as appropriate or inappropriate. Patients were assigned into 1 of 3 groups depending on whether the episode required ATP only, single shock, or multiple shocks, and then followed for all-cause mortality. Additionally, we aimed to determine the frequency with which inappropriate ATP precipitated ventricular arrhythmias that led to shock, since this has been suggested as a mechanism of harm.
Results: Over a mean follow-up of 39 ± 19 months, there were a total of 470 deaths (21%). Compared to patients with no treated episodes, patients with appropriate therapy had greater risk of death. Hazard ratios were 1.46 (95% confidence interval [CI] 1.05-2.02; P = 0.023) for the ATP-only group, 2.11 (95% CI 1.51-2.96; P < 0.001) for the single-shock group, and 2.55 (95% CI 1.43-4.57; P = 0.002) for the multishock group. There was no significant association between any type of inappropriate therapy and increased mortality. We identified only 7 instances of inappropriate ATP precipitating ventricular arrhythmia resulting in shock.
Conclusions: Patients receiving appropriate therapy of all types had increased mortality compared to those with no episodes. Furthermore, inappropriate ATP rarely precipitates ventricular arrhythmias.
(© 2015 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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