Advertisement

Clinical Research in Cardiology

, Volume 109, Issue 1, pp 89–95 | Cite as

Prognostic relevance of new onset arrhythmia and ICD shocks in primary prophylactic ICD patients

  • Thomas KleemannEmail author
  • Margit Strauss
  • Kleopatra Kouraki
  • Nicolas Werner
  • Ralf Zahn
Original Paper

Abstract

Background

The prognostic relevance of new onset arrhythmias compared to ICD shocks in ICD patients is not well known.

Objectives

Aim of the study was to evaluate the prognostic relevance of new onset atrial fibrillation (AF) or ventricular arrhythmias (VT/VF) compared to ICD shocks in primary prophylactic ICD-patients.

Methods

A total of 622 of 1955 (32%) patients of the prospective single-centre ICD-registry Ludwigshafen with primary prophylactic ICD indication and sinus rhythm (SR) at baseline without history of AF were analyzed. All patients underwent an ICD implantation between 1992 and 2012.

Results

During the median follow-up time of 6 years, 200 (32%) ICD patients developed new AF and 249 (40%) patients new VT/VF. There was an approximately 10% increase of 5-year mortality rate depending on the type of new onset arrhythmia (no arrhythmia 19%, new AF 28%, new VT 36% and new VF 55% 5-year mortality). In a multivariate analysis, new onset of AF or VT/VF was an independent predictor for increased mortality whereas VT shocks and inappropriate ICD shocks were not.

Conclusion

More than half of primary prophylactic ICD patients with SR at baseline develop new AF or VT/VF after 6 years. New onset arrhythmias of AF and VT/VF are independent prognostic factors for increased mortality in primary prophylactic ICD patients. ICD shocks itself, inappropriate or appropriate, are not additionally associated with a worse outcome. These results support the hypothesis that in clinical practice rather the arrhythmia than the ICD shock itself is responsible for a deteriorated prognosis.

Keywords

Atrial fibrillation Arrhythmia Defibrillation Implantable cardioverter defibrillator (ICD) ICD shock Prognosis Ventricular arrhythmia 

Notes

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standards

The ICD registry was approved by the local ethics committee of the Landesärztekammer Rheinland Pfalz. The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All patients gave their informed consent for their inclusion into the ICD registry.

References

  1. 1.
    Poole JE, Johnson GW, Hellkamp AS, Anderson J, Callans DJ, Raitt MH et al (2008) Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med 359:1009–1017CrossRefGoogle Scholar
  2. 2.
    Bunch TJ, Day JD, Olshansky B, Stolen KQ, Mullin CM, INTRINSIC RV Study Investigators (2009) Newly detected atrial fibrillation in patients with an implantable cardioverter-defibrillator is a strong risk marker of increased mortality. Heart Rhythm. 6:2–8CrossRefGoogle Scholar
  3. 3.
    Moss AJ, Greenberg H, Case RB, Zareba W, Hall WJ, Brown MW et al (2004) Long-term clinical course of patients after termination of ventricular tachyarrhythmia by an implanted defibrillator. Circulation 110:3760–3765CrossRefGoogle Scholar
  4. 4.
    Moss AJ, Schuger C, Beck CA, Brown MW, Cannom DS, Daubert JP et al (2012) Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med 367:2275–2283CrossRefGoogle Scholar
  5. 5.
    Bänsch D, Antz M, Boczor S, Volkmer M, Tebbenjohanns J, Seidl K et al (2002) Primary prevention of sudden cardiac death in idiopathic dilated cardiomyopathy: the Cardiomyopathy Trial (CAT). Circulation 105:1453–1458CrossRefGoogle Scholar
  6. 6.
    Kleemann T, Strauss M, Kouraki K, Zahn R (2015) Clinical course and prognostic relevance of antitachycardia pacing-terminated ventricular tachyarrhythmias in implantable cardioverter-defibrillator patients. Europace. 17:1068–1075CrossRefGoogle Scholar
  7. 7.
    Powell BD, Saxon LA, Boehmer JP, Day JD, Gilliam Iii FR, Heidenreich PA et al (2013) Survival after shock therapy in implantable cardioverter-defibrillator and cardiac resynchronization therapy-defibrillator recipients according to rhythm shocked: the altitude survival by rhythm study. J Am Coll Cardiol 62:1674–1679CrossRefGoogle Scholar
  8. 8.
    Jiménez-Candil J, Hernández J, Perdiguero P, Martín A, Moríñigo J, Bravo L et al (2016) Prognostic significance of nonsustained ventricular tachycardia episodes occurring early after implantable cardioverter-defibrillator implantation among patients with left ventricular dysfunction. Am J Cardiol 118:1503–1510CrossRefGoogle Scholar
  9. 9.
    Kleemann T, Hochadel M, Strauss M, Skarlos A, Seidl K, Zahn R (2012) Comparison between atrial fibrillation-triggered implantable cardioverter-defibrillator (ICD) shocks and inappropriate shocks caused by lead failure: different impact on prognosis in clinical practice. J Cardiovasc Electrophysiol 23:735–740CrossRefGoogle Scholar
  10. 10.
    Marrouche NF, Brachmann J, Andresen D, Siebels J, Boersma L, Jordaens L et al (2018) Catheter ablation for atrial fibrillation with heart failure. N Engl J Med 378:417–427CrossRefGoogle Scholar
  11. 11.
    Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L et al (2005) The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 352:1539–1549CrossRefGoogle Scholar
  12. 12.
    Ruwald AC, Schuger C, Moss AJ, Kutyifa V, Olshansky B, Greenberg H et al (2014) Mortality reduction in relation to implantable cardioverter defibrillator programming in the multicenter automatic defibrillator implantation trial-reduce inappropriate therapy (MADIT-RIT). Circ Arrhythm Electrophysiol 7:785–792CrossRefGoogle Scholar
  13. 13.
    Tan VH, Wilton SB, Kuriachan V, Sumner GL, Exner DV (2014) Impact of programming strategies aimed at reducing nonessential implantable cardioverter defibrillator therapies on mortality: a systematic review and meta-analysis. Circ Arrhythm Electrophysiol 7:164–170CrossRefGoogle Scholar
  14. 14.
    Scott PA, Silberbauer J, McDonagh TA, Murgatroyd FD (2014) Impact of prolonged implantable cardioverter-defibrillator arrhythmia detection times on outcomes: a meta-analysis. Heart Rhythm 11:828–835CrossRefGoogle Scholar
  15. 15.
    Wilkoff BL, Williamson BD, Stern RS, Moore SL, Lu F, Lee SW et al (2008) Strategic programming of detection and therapy parameters in implantable cardioverter-defibrillators reduces shocks in primary prevention patients: results from the PREPARE (primary prevention parameters evaluation) study. J Am Coll Cardiol 52:541–550CrossRefGoogle Scholar
  16. 16.
    Goldenberg I, Moss AJ, Hall WJ, McNitt S, Zareba W, Andrews ML et al (2006) Causes and consequences of heart failure after prophylactic implantation of a defibrillator in the multicenter automatic defibrillator implantation trial II. Circulation 113:2810–2817CrossRefGoogle Scholar
  17. 17.
    The antiarrhythmics versus implantable defibrillators (AVID) investigators (1997) A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med 1997(337):1576–1583Google Scholar
  18. 18.
    Wathen MS, DeGroot PJ, Sweeney MO, Stark AJ, Ottemess MF, Adkisson WO et al (2004) Prospective randomized multicentre trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter defibrillators. PainFREE Rx II Trial Results. Circulation 110:2592–2596CrossRefGoogle Scholar
  19. 19.
    Wilkoff BL, Ousdigian KT, Sterns LD, Wang ZJ, Wilson RD, Morgan JM, EMPIRIC Trial Investigators (2006) A comparison of empiric to physician-tailored programming of implantable cardioverter-defibrillators: results from the prospective randomized multicenter EMPIRIC trial. J Am Coll Cardiol 48:330–339CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Thomas Kleemann
    • 1
    Email author
  • Margit Strauss
    • 1
  • Kleopatra Kouraki
    • 1
  • Nicolas Werner
    • 1
  • Ralf Zahn
    • 1
  1. 1.Klinikum Ludwigshafen, Medizinische Klinik BLudwigshafenGermany

Personalised recommendations