Cardiac defibrillator implantation in patients with syncope and inducible ventricular arrhythmia: insights from the German Device Registry.

Autor: Kahle AK; Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, Cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217, Düsseldorf, Germany.; Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany.; Institute of Neural and Sensory Physiology, Medical Faculty, cNEP, Cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Düsseldorf, Germany., Senges J; Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany., Hochadel M; Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany., Brachmann J; Medical School REGIOMED, Coburg, Germany.; University of Split School of Medicine, Split, Croatia., Thomas D; Department of Cardiology, Medical University Hospital, Heidelberg, Germany.; DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg/Mannheim, Heidelberg, Germany., Straube F; Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany., Bonaventura K; Department of Internal Medicine/Cardiology and Angiology, Ernst-Von-Bergmann Clinic, Potsdam, Germany., Larbig R; Division of Cardiology, Hospital Maria Hilf Mönchengladbach, Mönchengladbach, Germany., Werner N; Department of Cardiology, University Heart Centre Bonn, Bonn, Germany.; Medical Department III, Krankenhaus der Barmherzigen Brüder Trier, Trier, Germany., Butter C; Department of Cardiology, Heart Center Brandenburg Bernau, Bernau, Germany., Alken FA; Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, Cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217, Düsseldorf, Germany.; Institute of Neural and Sensory Physiology, Medical Faculty, cNEP, Cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Düsseldorf, Germany., Meyer C; Division of Cardiology, Angiology, Intensive Care Medicine, EVK Düsseldorf, cNEP, Cardiac Neuro- and Electrophysiology Research Consortium, Kirchfeldstrasse 40, 40217, Düsseldorf, Germany. c.mey@web.de.; Institute of Neural and Sensory Physiology, Medical Faculty, cNEP, Cardiac Neuro- and Electrophysiology Research Consortium, Heinrich Heine University Düsseldorf, Düsseldorf, Germany. c.mey@web.de.
Jazyk: angličtina
Zdroj: Scientific reports [Sci Rep] 2023 Jul 27; Vol. 13 (1), pp. 12182. Date of Electronic Publication: 2023 Jul 27.
DOI: 10.1038/s41598-023-37440-2
Abstrakt: History of syncope is an independent predictor for sudden cardiac death. Programmed stimulation may be considered for risk stratification, but data remain sparse among different populations. Here, we analyzed the prognostic value of inducible ventricular arrhythmia (VA) regarding clinical outcome in patients with syncope undergoing defibrillator implantation. Among 4196 patients enrolled in the prospective, multi-center German Device Registry, patients with syncope and inducible VA (n = 285, 6.8%) vs. those with a secondary preventive indication (n = 1885, 45.2%), defined as previously documented sustained ventricular tachycardia or ventricular fibrillation, serving as a control group were studied regarding demographics, device implantation and post-procedural adverse events. Patients with syncope and inducible VA (64.9 ± 14.4 years, 81.1% male) presented less frequently with congestive heart failure (15.1% vs. 29.1%; p < 0.001) and any structural heart disease (84.9% vs. 89.3%; p = 0.030) than patients with a secondary preventive indication (65.0 ± 13.8 years, 81.0% male). Whereas dilated cardiomyopathy (16.8% vs. 23.8%; p = 0.009) was less common, hypertrophic cardiomyopathy (5.6% vs. 2.8%; p = 0.010) and Brugada syndrome (2.1% vs. 0.3%; p < 0.001) were present more often. During 1-year-follow-up, mortality (5.1% vs. 8.9%; p = 0.036) and the rate of major adverse cardiac or cerebrovascular events (5.8% vs. 10.0%; p = 0.027) were lower in patients with syncope and inducible VA. Among patients with inducible VA, post-procedural adverse events including rehospitalization (27.6% vs. 21.7%; p = 0.37) did not differ between those with vs. without syncope. Taken together, patients with syncope and inducible VA have better clinical outcomes than patients with a secondary preventive defibrillator indication, but comparable outcomes to patients without syncope, which underlines the relevance of VA inducibility, potentially irrespective of a syncope.
(© 2023. The Author(s).)
Databáze: MEDLINE
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