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Pol. Merkur. Lek (Pol. Med. J.), 2016, XL/238: 216-222 Maximize

Pol. Merkur. Lek (Pol. Med. J.), 2016, XL/238: 216-222

Title: Arrhythmia, device interventions and mortality analysis in patients with implanted cardioverter-defibrillator with/without resynchronisation therapy in dilative cardiomyopathy in primary prevention of sudden cardiac death 

Authors: Lelakowski J, Pudło J, Lelakowska-Pieła M, Rydlewska A, Piekarz J, Domaracki D. 

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SUMMARY IN POLISH & ENGLISH. FULL ARTICLE ONLY IN POLISH.

Arrhythmia, device interventions and mortality analysis in patients with implanted cardioverter-defibrillator with/without resynchronisation therapy in dilative cardiomyopathy in primary prevention of sudden cardiac death

Lelakowski J1, Pudło J1, Lelakowska-Pieła M2, Rydlewska A1, Piekarz J1, Domaracki D2.

1Jagiellonian University, Institute of Cardiology, Department of Electrocardiology. The John Paul II Hospital in Kraków. 2The Hospital in Chrzanów, Department of Cardiology. 3The John Paul II Hospital in Kraków.

Ambulatory follow-up of patients with implanted cardioverter-defibrillator (ICD) with/without resynchronisation therapy (CRTD) requires regular visits to assess arrhythmias, device interventions and mortality.
The aim of the study
was to examine arrhythmia prevalence, device interventions and mortality in patients with dilative cardiomyopathy with ICD/CRTD implanted in primary sudden cardiac death (SCD) prevention.
Material and methods
. The study consisted of patients with ICD and/or CRTD implanted between 2010-2011. The inclusion criteria were: left ventricle ejection fraction (LVEF) ≤ 35%, NYHA class ≥ II, implantation in primary SCD prevention and in case of CRTD additionally LBBB with wide QRS≥120ms. All of patients’ visits in outpatient clinic were analysed. The following data were assessed: age, gender, presence of coronary artery disease (CAD), diabetes, thyroid gland diseases, chronic kidney failure, atrial fibrillation (AF), LVEF, NYHA class, device interventions, number of arrhythmias, changes in pharmacotherapy, device parameters and mortality.
Results
. The study analysed 360 patients (302 M, mean age 64±12 years) with cardiac implantable devices (127 with CRTD, 233 with ICD). During observation, which lasted the mean of 768±491 days, 258 patients had ventricular arrhythmias and 118 patients had adequate device interventions. 10 patients died because of the progression of heart failure. Ventricular arrhythmia was more frequent in patients with CRTD, who died, with low cholesterol level, high NYHA class, low LVEF, diabetes and kidney failure. Device interventions occurred in the above described groups and additionally in patients with AF. After step exclusion of characteristics with highest p value in Wald test, it was confirmed that the factors influencing ventricular arrhythmia and death were low LVEF (HR=0,944, p≤0,002 and HR=0,813, p≤0,013) and diabetes (HR=7,043, p≤0,009 and HR=29,931, p≤0,002).
Conclusions
. Ventricular arrhythmia is more often in patients with CRTD, who died, with low cholesterol level, high NYHA class, low LVEF, diabetes and kidney failure. Adequate interventions are more often in patients who died, with low cholesterol level, high NYHA class, low LVEF, diabetes, kidney failure and AF. Patients who died, compared to those who survived, had significantly more often lipid level anomalies, high NYHA class, low LVEF, advanced age, diabetes, kidney failure, atrial fibrillation, arterial hypertension, device interventions and pharmacotherapy changes. Diabetes and low LVEF are predictors of ventricular arrhythmias and death.

Key words: ICD, CRTD, ventricular arrhythmia, interventions, mortality

Pol Med J, 2016; XL (238); 216–222