Primary prevention of sudden cardiac death in a nonischemic dilated cardiomyopathy population: reappraisal of the role of programmed ventricular stimulation

Autor: Georgios Karystinos, Theodoros Gialernios, Petros Arsenos, Stefanos Archontakis, Ioannis Kallikazaros, Maria Salourou, Polychronis Dilaveris, Christodoulos Stefanadis, Konstantinos Gatzoulis, Dimitris Tsiachris, Apostolos-Ilias Vouliotis, Skevos Sideris
Rok vydání: 2013
Předmět:
Adult
Cardiomyopathy
Dilated
Male
medicine.medical_specialty
medicine.medical_treatment
Population
Kaplan-Meier Estimate
Ventricular tachycardia
Severity of Illness Index
Sudden cardiac death
Cohort Studies
Sex Factors
Physiology (medical)
Internal medicine
Idiopathic dilated cardiomyopathy
medicine
Confidence Intervals
Humans
Hospital Mortality
education
Aged
Proportional Hazards Models
Retrospective Studies
education.field_of_study
Ejection fraction
business.industry
Age Factors
Dilated cardiomyopathy
Stroke Volume
Middle Aged
medicine.disease
Implantable cardioverter-defibrillator
Survival Analysis
Defibrillators
Implantable
Death
Sudden
Cardiac
Treatment Outcome
Ventricular fibrillation
Ventricular Fibrillation
Cardiology
Tachycardia
Ventricular
Female
Cardiology and Cardiovascular Medicine
business
Follow-Up Studies
Zdroj: Circulation. Arrhythmia and electrophysiology. 6(3)
ISSN: 1941-3084
Popis: Background— We considered the role of programmed ventricular stimulation in primary prevention of sudden cardiac death in an idiopathic dilated cardiomyopathy population. Methods and Results— One hundred fifty-eight patients with idiopathic dilated cardiomyopathy underwent programmed ventricular stimulation. Ventricular tachycardia/ventricular fibrillation was triggered in 44 patients (group I, 27.8%) versus 114 patients (group II), where ventricular tachycardia/ventricular fibrillation was not induced. Sixty-nine patients with idiopathic dilated cardiomyopathy underwent implantable cardioverter-defibrillator (ICD) implantation: 41/44 in group I and 28/114 in group II. The major end points of the study were overall mortality and appropriate ICD activation. Overall mortality during the 46.9 months of mean follow-up was not significantly different between the 2 groups. Patients with left ventricular ejection fraction ≤35% (n=119) demonstrated a higher overall mortality rate compared with the patients with left ventricular ejection fraction >35% (n=39; 16.8% versus 10.3%, log-rank P =0.025). Advanced New York Heart Association class (III and IV versus I and II) was the single independent and strongest prognostic factor of overall mortality (hazard ratio, 11.909; P P =0.001; confidence interval, 2.958–73.922). Among ICD recipients, ICD activation rate was significantly higher in group I compared with group II (30 of 41 patients–73.2% versus 5 of 28 patients–17.9%; log-rank P =0.001), either in the form of antitachycardia pacing (68.3% versus 17.9%; log-rank P =0.001) or in the shock delivery form (51.2% versus 17.9%; log-rank P =0.05). Induction of ventricular tachycardia/ventricular fibrillation during programmed ventricular stimulation in contrast to left ventricular ejection fraction was the single independent prognostic factor for future ICD activation (hazard ratio, 4.195; P =0.007; confidence interval, 1.467–11.994). Conclusions— Inducibility of ventricular tachycardia/ventricular fibrillation was associated with an increased likelihood of subsequent ICD activation and sudden cardiac death surrogate.
Databáze: OpenAIRE
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