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Heart Rhythm. 2014 May;11(5):822-7. doi: 10.1016/j.hrthm.2014.02.007. Epub 2014 Feb 6.

Smoking is associated with an increased risk of first and recurrent ventricular tachyarrhythmias in ischemic and nonischemic patients with mild heart failure: a MADIT-CRT substudy.

Author information

1
University of Rochester Medical Center, Rochester, New York.
2
University of Rochester Medical Center, Rochester, New York. Electronic address: Mehmet_Aktas@urmc.rochester.edu.

Abstract

BACKGROUND:

Limited data exist regarding the proarrhythmic effects of smoking.

OBJECTIVE:

To evaluate the relationship between smoking and the risk of first and recurrent ventricular tachyarrhythmias (VTAs) in patients with mild heart failure.

METHODS:

The risk of a first and recurrent appropriate implantable cardioverter-defibrillator therapy for VTAs or death was compared between nonsmokers (n = 465), past smokers (n = 780), and current smokers (n = 197) in patients with ischemic and nonischemic cardiomyopathy who were enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy study.

RESULTS:

The cumulative probability of a first VTA or death was significantly higher in current smokers than in past and nonsmokers (P < .001). Multivariate analysis showed that current smokers had a significantly higher risk of first ventricular tachycardia/ventricular fibrillation or death (hazard ratio [HR] 1.51; 95% confidence interval [CI] 1.14-2.01; P = .005) and a higher risk for first ventricular tachycardia/ventricular fibrillation episode (HR 1.54, 95% CI 1.12-2.13, P = .008) than did nonsmokers. Past smokers had a risk of first VTAs or death similar to that of nonsmokers (HR 1.01; 95% CI 0.80-1.27; P = .953). In comparison to nonsmokers, the risk of recurrent VTAs was significantly higher in the total cohort of patients (HR 1.54; 95% CI 1.21-1.95; P < .001) and in the subgroups of patients with ischemic and nonischemic cardiomyopathy (HR 1.48; 95% CI 1.03-2.13; P = .035).

CONCLUSIONS:

Current smokers with left ventricular dysfunction and mild heart failure are at a significantly higher risk of VTAs or death than are past smokers and nonsmokers. Smoking is associated with a significant increase in the risk of recurrent VTAs in both patients with ischemic and nonischemic cardiomyopathy.

KEYWORDS:

Implantable cardioverter-defibrillator; Smoking; Ventricular fibrillation; Ventricular tachycardia

PMID:
24509214
DOI:
10.1016/j.hrthm.2014.02.007
[Indexed for MEDLINE]

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