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Int J Cardiol. 2019 Jan 1;274:163-169. doi: 10.1016/j.ijcard.2018.09.003. Epub 2018 Sep 5.

Survival and arrhythmic risk among ischemic and non-ischemic heart failure patients with prophylactic implantable cardioverter defibrillator only therapy: A propensity score-matched analysis.

Author information

1
Hospital Universitario Infanta Leonor, Madrid, Spain. Electronic address: semdoc@hotmail.com.
2
Hospital Universitario Infanta Leonor, Madrid, Spain.
3
Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
4
Hospital Universitario de Áraba, Álava, Spain.
5
Complejo Hospitalario Universitario de Vigo, Vigo, Spain.
6
Hospital Santa Creu i Sant Pau, Barcelona, Spain.
7
Hospital Universitario Gregorio Marañón, Madrid, Spain.
8
Hospital Virgen de la Victoria, Málaga, Spain.
9
Complejo Hospitalario de Navarra, Pamplona, Spain.
10
Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
11
Hospital Universitario Puerta de Hierro, Madrid, Spain.

Abstract

BACKGROUND:

Concerns about the efficacy of prophylactic ICD in non-ischemic cardiomyopathy (NICM) heart failure (HF) patients are still present. We aimed to assess whether survival and arrhythmic risk were different among ischemic cardiomyopathy (ICM) and NICM ICD-only patients, along with specific predictors for mortality.

METHODS:

HF patients undergoing ICD-only implant were extracted from the nationwide multicenter UMBRELLA registry. Arrhythmic events were collected by remote monitoring and reviewed by a committee of experts.

RESULTS:

782 patients (556 ICM; 226 NICM) were recruited: mean ejection fraction of 26.6%; 83.4% in NYHA class II-III; mean QRS duration of 108.9 ms (only 14.9% with QRS > 130 ms). After 4.35 years of mean follow-up, all-cause mortality rate was 4.2%/year. In propensity-score (PS) analysis no survival differences between ICM and NICM subgroups appeared (mortality rates: 19.4% vs. 20%, p = 0.375). Age (hazard ratio [HR] = 1.02, p = 0.009), diabetes (HR = 2.61, p ≤ 0.001), chronic obstructive pulmonary disease (HR = 2.13, p = 0.002), and previous HF (HR = 2.28, p = 0.027) correlated with increased mortality for the entire population, however atrial fibrillation (AF) (HR = 2.68, p = 0.002) and chronic kidney disease (HR = 3.74, p ≤ 0.001) emerged as specific predictors in NICM patients. At follow-up, 134 patients (17.1%) were delivered a first appropriate ICD therapy (5.1%/year) without significant differences between ICM and NICM patients in the PS analysis (17.6% vs. 15.8%, p = 0.968). ICD shocks were associated with a higher mortality (HR = 2.88, p < 0.001) but longer detection windows (HR = 0.57, p = 0.042) correlated with fewer appropriate therapies.

CONCLUSIONS:

Mortality and arrhythmia free survival is similar among ICM and NICM HF patients undergoing ICD-only implant for primary prevention strategy.

KEYWORDS:

Implantable cardioverter defibrillator; Non-ischemic cardiomyopathy; Survival, arrhythmic risk

PMID:
30206014
DOI:
10.1016/j.ijcard.2018.09.003
[Indexed for MEDLINE]

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