Prognostic impact of recurrences of ventricular tachyarrhythmias and appropriate ICD therapies in a high-risk ICD population
The study sought to evaluate the prognostic impact of recurrences of ventricular tachyarrhythmias in consecutive ICD recipients with ventricular tachyarrhythmias on admission.
All consecutive patients surviving at least one episode of ventricular tachyarrhythmias from 2002 to 2016 and discharged with an ICD (pre-existing ICD or ICD implantation at index hospitalization) were included. The primary endpoint was all-cause mortality according to the presence or absence of recurrences of ventricular tachyarrhythmias at 5 years. Secondary endpoints comprised the impact of different types of recurrences, appropriate ICD therapies, as well as predictors of recurrences and appropriate ICD therapies. Kaplan–Meier, multivariable Cox regression and propensity score matching analyses were applied.
A total of 592 consecutive ICD recipients was included (44% with recurrences of ventricular tachyarrhythmias and 56% without). Recurrences of ventricular tachyarrhythmias were associated with increased all-cause mortality at 5 years (HR = 1.498; 95% CI = 1.052–2.132; p = 0.025). Worst survival was observed in patients with sustained VT or VF as first recurrences compared to non-sustained VT, as well as in patients with cumulative recurrences of non-sustained or sustained VT plus VF, whereas mortality was not affected by the number of recurrences of ventricular tachyarrhythmias (> 4 vs. ≤ 4). Moreover, appropriate ICD therapies were associated with increased all-cause mortality (HR = 1.874; 95% CI = 1.318–2.666; p = 0.001), mainly attributed to secondary preventive ICDs. Finally, atrial fibrillation, LVEF < 35% and non-ischemic cardiomyopathy were identified as predictors of recurrences of ventricular tachyarrhythmias and appropriate ICD therapies.
Recurrences of ventricular tachyarrhythmias and recurrent appropriate ICD therapies are associated with increased long-term all-cause mortality in consecutive ICD recipients. Non-ischemic cardiomyopathy, AF and LVEF < 35% revealed to be significant predictors of both endpoints.
KeywordsRecurrences Ventricular tachyarrhythmia Ventricular tachycardia Ventricular fibrillation ICD Mortality
Compliance with ethical standards
Conflict of interest
The authors declare that they do not have any conflict of interest.
- 1.Priori SG, Blomstrom-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekval TM, Spaulding C, Van Veldhuisen DJ (2015) 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 36:2793–2867CrossRefGoogle Scholar
- 2.van der Heijden AC, Borleffs CJ, Buiten MS, Thijssen J, van Rees JB, Cannegieter SC, Schalij MJ, van Erven L (2015) The clinical course of patients with implantable cardioverter-defibrillators: extended experience on clinical outcome, device replacements, and device-related complications. Heart Rhythm 12:1169–1176CrossRefGoogle Scholar
- 3.Luker J, Sultan A, Plenge T, van den Bruck J, Heeger CH, Meyer S, Mischke K, Tilz RR, Vollmann D, Nolker G, Schaffer B, Willems S, Steven D (2018) Electrical cardioversion of patients with implanted pacemaker or cardioverter-defibrillator: results of a survey of german centers and systematic review of the literature. Clin Res Cardiol 107:249–258CrossRefGoogle Scholar
- 6.Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, Domanski M, Troutman C, Anderson J, Johnson G, McNulty SE, Clapp-Channing N, Davidson-Ray LD, Fraulo ES, Fishbein DP, Luceri RM (2005) Ip JH and sudden cardiac death in heart failure trial I. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 352:225–237CrossRefGoogle Scholar
- 8.Patel NJ, Edla S, Deshmukh A, Nalluri N, Patel N, Agnihotri K, Patel A, Savani C, Patel N, Bhimani R, Thakkar B, Arora S, Asti D, Badheka AO, Parikh V, Mitrani RD, Noseworthy P, Paydak H, Viles-Gonzalez J, Friedman PA, Kowalski M (2016) Gender, racial, and health insurance differences in the trend of implantable cardioverter-defibrillator (ICD) utilization: a united states experience over the last decade. Clin Cardiol 39:63–71CrossRefGoogle Scholar
- 14.Poole JE, Johnson GW, Hellkamp AS, Anderson J, Callans DJ, Raitt MH, Reddy RK, Marchlinski FE, Yee R, Guarnieri T, Talajic M, Wilber DJ, Fishbein DP, Packer DL, Mark DB, Lee KL, Bardy GH (2008) Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med 359:1009–1017CrossRefGoogle Scholar
- 16.Dickstein K, Vardas PE, Auricchio A, Daubert JC, Linde C, McMurray J, Ponikowski P, Priori SG, Sutton R, van Veldhuisen DJ (2010) Focused Update of ESC Guidelines on device therapy in heart failure: an update of the 2008 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC guidelines for cardiac and resynchronization therapy. Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association. Eur Heart J 31:2677–2687CrossRefGoogle Scholar
- 17.Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, Deal BJ, Dickfeld T, Field ME, Fonarow GC, Gillis AM, Hlatky MA, Granger CB, Hammill SC, Joglar JA, Kay GN, Matlock DD, Myerburg RJ, Page RL (2017) 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 72:91–220CrossRefGoogle Scholar
- 19.Authors/Task Force M, Dickstein K, Vardas PE, Auricchio A, Daubert J-C, Linde C, McMurray J, Ponikowski P, Priori SG, Sutton R, van Veldhuisen DJ, Guidelines ESCCfP, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas P, Widimsky P, Document R, Tendera M, Anker SD, Blanc J-J, Gasparini M, Hoes AW, Israel CW, Kalarus Z, Merkely B, Swedberg K, Camm AJ (2010) 2010 Focused Update of ESC Guidelines on device therapy in heart failureAn update of the 2008 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC Guidelines for cardiac and resynchronization therapyDeveloped with the special contribution of the Heart Failure Association and the European Heart Rhythm Association. EP Europace 12:1526–1536CrossRefGoogle Scholar
- 22.Weeke P, Johansen JB, Jorgensen OD, Nielsen JC, Moller M, Videbaek R, Hojgaard MV, Riahi S, Jacobsen PK (2013) Mortality and appropriate and inappropriate therapy in patients with ischaemic heart disease and implanted cardioverter-defibrillators for primary prevention: data from the Danish ICD Register. Europace 15:1150–1157CrossRefGoogle Scholar
- 24.Ucar FM, Yilmaztepe MA, Taylan G, Aktoz M (2017) Non-sustained ventricular tachycardia episodes predict future hospitalization in ICD recipients with heart failure. Arquivos Brasil Cardiol 109:284–289Google Scholar
- 31.Olgin JE, Pletcher MJ, Vittinghoff E, Wranicz J, Malik R, Morin DP, Zweibel S, Buxton AE, Elayi CS, Chung EH, Rashba E, Borggrefe M, Hue TF, Maguire C, Lin F, Simon JA, Hulley S, Lee BK (2018) Wearable cardioverter-defibrillator after myocardial infarction. N Engl J Med 379:1205–1215CrossRefGoogle Scholar
- 32.Duncker D, Westenfeld R, Konrad T, Pfeffer T, Correia de Freitas CA, Pfister R, Thomas D, Furnkranz A, Andrie RP, Napp A, Schmitt J, Karolyi L, Wakili R, Hilfiker-Kleiner D, Bauersachs J, Veltmann C (2017) Risk for life-threatening arrhythmia in newly diagnosed peripartum cardiomyopathy with low ejection fraction: a German multi-centre analysis. Clin Res Cardiol 106:582–589CrossRefGoogle Scholar
- 34.Thomas D, Christ T, Fabritz L, Goette A, Hammwohner M, Heijman J, Kockskamper J, Linz D, Odening KE, Schweizer PA, Wakili R, Voigt N (2018) German Cardiac Society Working Group on Cellular Electrophysiology state-of-the-art paper: impact of molecular mechanisms on clinical arrhythmia management. Clin Res Cardiol. https://doi.org/10.1007/s00392-018-1377-1 Google Scholar
- 38.Bunz M, Lenski D, Wedegartner S, Ukena C, Karbach J, Bohm M, Kindermann I (2016) Heart-focused anxiety in patients with chronic heart failure before implantation of an implantable cardioverter defibrillator: baseline findings of the Anxiety-CHF Study. Clin Res Cardiol 105:216–224CrossRefGoogle Scholar
- 39.Zaman S, Sivagangabalan G, Chik W, Stafford W, Hayes J, Denman R, Young G, Sanders P, Kovoor P (2014) Ventricular tachyarrhythmia recurrence in primary versus secondary implantable cardioverter-defibrillator patients and role of electrophysiology study. J Interventional Cardiac Electrophysiol 41:195–202CrossRefGoogle Scholar
- 40.Sweeney MO, Wathen MS, Volosin K, Abdalla I, DeGroot PJ, Otterness MF, Stark AJ (2005) Appropriate and inappropriate ventricular therapies, quality of life, and mortality among primary and secondary prevention implantable cardioverter defibrillator patients: results from the Pacing Fast VT REduces Shock ThErapies (PainFREE Rx II) trial. Circulation 111:2898–2905CrossRefGoogle Scholar
- 42.Wolff G, Lin Y, Karathanos A, Brockmeyer M, Wolters S, Nowak B, Furnkranz A, Makimoto H, Kelm M, Schulze V (2017) Implantable cardioverter/defibrillators for primary prevention in dilated cardiomyopathy post-DANISH: an updated meta-analysis and systematic review of randomized controlled trials. Clin Res Cardiol 106:501–513CrossRefGoogle Scholar
- 45.Busch S, Forkmann M, Kuck KH, Lewalter T, Ince H, Straube F, Wieneke H, Julian Chun KR, Eckardt L, Schmitt C, Hochadel M, Senges J, Brachmann J (2018) Acute and long-term outcome of focal atrial tachycardia ablation in the real world: results of the german ablation registry. Clin Res Cardiol 107:430–436CrossRefGoogle Scholar