Long-term prognosis and prognostic factors after primary prophylactic implantable cardioverter-defibrillator therapy.

Autor: Sugawara M; Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan., Kondo Y; Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan. Electronic address: simokita9933@msn.com., Ryuzaki S; Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan., Yoshino Y; Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan., Chiba T; Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan., Ito R; Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan., Kajiyama T; Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan., Nakano M; Department of Advanced Cardiorhythm Therapeutics, Chiba University Graduate School of Medicine, Chiba, Japan., Kobayashi Y; Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
Jazyk: angličtina
Zdroj: Journal of cardiology [J Cardiol] 2024 Sep; Vol. 84 (3), pp. 170-176. Date of Electronic Publication: 2024 Feb 20.
DOI: 10.1016/j.jjcc.2024.02.006
Abstrakt: Background: Little is known regarding which patients with ischemic cardiomyopathy (ICM) should be considered for prophylactic therapies, such as an implantable cardioverter-defibrillator (ICD), in the primary percutaneous intervention era. The aim of this study was to investigate the influence of non-sustained ventricular tachycardia (NSVT) on major adverse cardiac events (MACE) in heart failure with reduced ejection fraction (HFrEF) patients.
Methods: We retrospectively analyzed patients of ICM and non-ICM who underwent ICD implantation at our institute from October 2006 to August 2020. MACE were defined as composite outcome of cardiovascular death, heart failure hospitalization, and appropriate ICD therapies.
Results: A total of 167 patients were enrolled [male, 138 (83 %); age, 62.1 ± 11.7 years; left ventricular ejection fraction, 23.5 ± 6.1 %; left ventricular diastolic diameter, 67.4 ± 9.0 mm; atrial fibrillation, 47 (28 %); NSVT, 124 (74 %); use of class III antiarrhythmic drugs, 55 (33 %); ischemic cardiomyopathy, 56 (34 %); cardiac resynchronization therapy, 73 (44 %)]. The median follow-up duration was 61 months. MACE occurred with 71 patients (43 %). When comparing baseline characteristics of the patients, left ventricular ejection fraction (p = 0.02) and atrial fibrillation (p = 0.04) were significantly associated with MACE. The multivariable Cox analysis for the target variable MACE identified atrial fibrillation (hazard ratio 2.00; 95 % confidence index 1.18-3.37; p = 0.01) as an independent predictor for MACE.
Conclusions: Prior NSVT before ICD implantation was not an independent predictor of future MACE in patients with HFrEF with primary prophylactic ICD. In contrast, atrial fibrillation was associated with worse prognosis. To predict the prognosis of patients with primary prophylactic ICD, these factors should be assessed as comprehensive risk stratification factors for MACE.
Competing Interests: Declaration of competing interest This study did not receive any specific funding. Dr. Kondo received lecture fees from Daiichi-Sankyo, Bayer, Abbott Medical Japan, Biotronik Japan, Boston Scientific, Japan Lifeline, and research funds from Daiichi-Sankyo. Dr. Kobayashi received lecture fees from Abbott Medical Japan, Bayer Japan, Bristol-Myers Squibb, Boehringer Ingelheim, Daiichi-Sankyo, and scholarship funds from Takeda Pharmaceutical, Abbott Medical Japan, Terumo, Otsuka Pharmaceutical, Boehringer Ingelheim, Astellas, Daiichi-Sankyo, Win International, Japan Lifeline, and Nipro.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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