Ventricular arrhythmia storms in postinfarction patients with implantable defibrillators for primary prevention indications: A MADIT-II substudy
| Autor: | Benjamin McClinitic, David T. Huang, Arthur J. Moss, Scott McNitt, Henry W. Sesselberg, Mark L. Andrews, James P. Daubert, W. Jackson Hall, Wojciech Zareba |
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| Rok vydání: | 2007 |
| Předmět: |
Male
Tachycardia medicine.medical_specialty Time Factors animal diseases Myocardial Infarction Ventricular tachycardia Coronary artery disease Risk Factors Physiology (medical) Internal medicine Humans Medicine Prospective Studies Aged Heart Failure business.industry Hazard ratio Stroke Volume Middle Aged medicine.disease Defibrillators Implantable Primary Prevention Heart failure Ventricular Fibrillation Ventricular fibrillation Tachycardia Ventricular Cardiology Myocardial infarction complications Female medicine.symptom Cardiology and Cardiovascular Medicine business Multicenter Automatic Defibrillator Implantation Trial |
| Zdroj: | Heart Rhythm. 4:1395-1402 |
| ISSN: | 1547-5271 |
| DOI: | 10.1016/j.hrthm.2007.07.013 |
| Popis: | Much of prognostic implications of ventricular arrhythmia storms remain unclear.We evaluated the risk associated with electrical storm in patients with defibrillators in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II) study.Electrical storm was defined asor =3 episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) in 24 hours.Of the 719 patients who received internal cardiac defibrillator (ICD) implants and had follow-up in the MADIT-II, 27 patients (4%) had electrical storm, 142 (20%) had isolated episodes of VT/VF, and the remaining 550 patients had no ICD-recorded VT events. Baseline clinical characteristics among the groups were similar. Patients who experienced electrical storm had a significantly higher risk of death. After adjustments for relevant clinical covariates, the hazard ratio (HR) for death in the first 3 months after the storm event was 17.8 (95% confidence interval [CI] 8.0 to 39.5, P.01) in comparison with those with no VT/VF. This risk continued even after 3 months for those with electrical storm (HR of 3.5, 95% CI 1.2 to 9.8, P = .02). Study patients with isolated VT/VF episodes also were at an increased risk of dying (HR = 2.5, 95% CI 1.5 to 4.0, P.01) when compared with patients without VT/VF episodes. Statistically significant predictors of electrical storm were interim postenrollment coronary events (myocardial infarction or angina) HR 3.1 (95% CI 1.2 to 8.1, P = .02) and isolated VT or VF HR 9.2 (95% CI 4.0 to 20.9, P.01).Postinfarction patients with severe left ventricular dysfunction in whom electrical storm developed have significantly higher mortality than patients with only isolated VT/VF as well as those without any episodes of VT/VF. Patients who experienced postenrollment ventricular arrhythmias and/or interim coronary events during follow-up were at higher risk for VT/VF storms. |
| Databáze: | OpenAIRE |
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