Implantable cardioverter defibrillator therapy in young patients with cardiomyopathies and channelopathies: a single Italian centre experience

Autor: Loira Leoni, Emanuele Bertaglia, Domenico Corrado, Pietro De Franceschi, Maria Silvano, Sabino Iliceto, Alessandro Zorzi, Mariachiara Siciliano, Federico Migliore
Rok vydání: 2016
Předmět:
Male
Pediatrics
medicine.medical_treatment
cardiomyopathies
channelopathies
implantable cardioverter defibrillator complications
lead extraction
lead failure
sudden death
ventricular tachycardia
Adult
Arrhythmias
Cardiac
Cardiomyopathies
Channelopathies
Death
Sudden
Cardiac
Female
Follow-Up Studies
Heart Conduction System
Heart Failure
Humans
Italy
Kaplan-Meier Estimate
Multivariate Analysis
Proportional Hazards Models
Prospective Studies
Risk Assessment
Survival Rate
Treatment Outcome
Young Adult
Defibrillators
Implantable
Cardiology and Cardiovascular Medicine
Arrhythmias
030204 cardiovascular system & hematology
Ventricular tachycardia
0302 clinical medicine
Medicine
Brugada syndrome
Hypertrophic cardiomyopathy
Dilated cardiomyopathy
General Medicine
Implantable cardioverter-defibrillator
Death
Cardiology
Implantable
Cardiac
medicine.medical_specialty
Sudden death
Right ventricular cardiomyopathy
03 medical and health sciences
030225 pediatrics
Internal medicine
business.industry
medicine.disease
Sudden
Heart failure
business
Defibrillators
Zdroj: Journal of cardiovascular medicine (Hagerstown, Md.). 17(7)
ISSN: 1558-2035
Popis: AIMS This study was designed to prospectively evaluate the risk-benefit ratio of implantable cardioverter defibrillator (ICD) therapy in young patients with cardiomyopathies and channelopathies. METHODS AND RESULTS The study population included 96 consecutive patients [68 men, median age 27 (22-32) years] with cardiomyopathies, such as arrhythmogenic right ventricular cardiomyopathy (n = 35), dilated cardiomyopathy (n = 17), hypertrophic cardiomyopathy (n = 15), Brugada syndrome (n = 14), idiopathic ventricular fibrillation (n = 5), left ventricular noncompaction (n = 4), long-QT syndrome (n = 4) and short-QT syndrome (n = 2), who were 18-35 years old at the time of ICD implantation. During a mean follow-up of 72.6 ± 53.3 months, one patient with end-stage hypertrophic cardiomyopathy died because of acute heart failure, and 11 patients underwent orthotopic heart transplantation. Twenty patients (20.8%) had a total of 38 appropriate ICD interventions (4%/year), and 26 patients (27.1%) experienced a total of 49 adverse ICD-related events (5.4%/year), including 23 inappropriate ICD interventions occurring in nine patients (9.4%) and 26 device-related complications requiring surgical revision occurring in 20 patients (20.8%). Lead failure/fracture requiring lead extraction was the most common complication (n = 9). A threshold for ICD therapy less than 300 ms was associated with a borderline significant lower probability of inappropriate ICD interventions (hazard ratio = 0.2; 95% confidence interval 0.02-1.2; P = 0.07), whereas underweight status was an independent predictor of device-related complications (hazard ratio = 5.4; 95% confidence interval 1.5-19.4; P = 0.01). CONCLUSION In young patients with cardiomyopathies and channelopathies, ICD therapy provided life-saving protection by effectively terminating life-threatening ventricular arrhythmias. However, because ICD-related adverse events are common, the risk/benefit ratio should be carefully assessed when considering ICD implantation in young people.
Databáze: OpenAIRE
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