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Ventricular tachyarrhythmia recurrence in primary versus secondary implantable cardioverter-defibrillator patients and role of electrophysiology study.
- Source :
-
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2014 Dec; Vol. 41 (3), pp. 195-202. Date of Electronic Publication: 2014 Sep 30. - Publication Year :
- 2014
-
Abstract
- Purpose: In recent years, there has been a shift away from performing electrophysiologic study (EPS) to guide implantable cardioverter-defibrillator (ICD) implantation with a reliance on left ventricular ejection fraction (LVEF) alone.<br />Methods: ICD patients were prospectively recruited from the multicentre COMFORT (Concept of Optimal Management of ventricular Fibrillation Or Very fast ventricular Tachycardia) trial. Primary prevention ICD patients (n = 260, groups 1 and 2) were compared to secondary prevention ICD patients (n = 210, group 3). Primary prevention ICDs were implanted in patients with ischemic cardiomyopathy based on LVEF ≤ 40 % and inducible ventricular tachycardia (VT) at EPS (n = 123, group 1) or impaired LVEF alone (LVEF ≤ 30 % or LVEF ≤ 35 % with NYHA class II or III; n = 137, group 2). EPS was performed in 61 % of secondary prevention ICD patients (n = 129). Patients were followed up for >12 months with a primary endpoint of spontaneous VT/ventricular fibrillation (VF).<br />Results: A significantly higher rate of spontaneous VT/VF occurred in secondary versus primary prevention ICD patients (P < 0.001) and in EPS-guided versus LVEF-guided primary prevention ICD patients (P = 0.029). At 2 years, the proportion of patients with ≥1 VT/VF episode was 24.6 ± 4.2 %, 19.9 ± 4.6 % and 37.1 ± 3.9 % for groups 1, 2 and 3, respectively. In the secondary prevention, patients who underwent EPS, VT/VF occurred in 44.4 ± 5.9 % and 14.1 ± 6.6 % with a positive versus negative result, respectively (P = 0.02).<br />Conclusions: Secondary prevention ICD patients have more spontaneous VT/VF than primary prevention ICD patients. Secondary and primary prevention ICD patients with inducible VT at EPS have more VT/VF than patients without inducible VT or impaired LVEF alone.
- Subjects :
- Australia epidemiology
Disease-Free Survival
Electrophysiologic Techniques, Cardiac
Female
Humans
Incidence
Male
Middle Aged
Recurrence
Risk Factors
Tachycardia, Ventricular diagnosis
Tachycardia, Ventricular epidemiology
Treatment Outcome
Ventricular Fibrillation diagnosis
Ventricular Fibrillation epidemiology
Defibrillators, Implantable statistics & numerical data
Primary Prevention statistics & numerical data
Secondary Prevention statistics & numerical data
Tachycardia, Ventricular prevention & control
Ventricular Fibrillation prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1572-8595
- Volume :
- 41
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
- Publication Type :
- Academic Journal
- Accession number :
- 25267274
- Full Text :
- https://doi.org/10.1007/s10840-014-9941-8