In:
Pacing and Clinical Electrophysiology, Wiley, Vol. 38, No. 5 ( 2015-05), p. 547-557
Abstract:
In heart failure patients with implantable cardioverter defibrillator (ICD) the risk of death from causes other than tachyarrhythmia is substantial. Benefit from ICD is determined by two competing risks: appropriate ICD shock or nonarrhythmic death. The goal of the study was to test predictors of competing outcomes. Methods Patients with structural heart disease (N = 234, mean age 58.5 ± 15.1; 71% men, 80% whites, 61% ischemic cardiomyopathy) and primary (75%) or secondary prevention ICD underwent a 5‐minute baseline near‐field electrogram (NF EGM) recording. VV′ alternans triplets were quantified as a percentage of three sinus VV′ cycles sequences of “short‐long‐short” or “long‐short‐long” order. Appropriate ICD shock for fast ventricular tachycardia (FVT, cycle length ≤240 ms)/ventricular fibrillation (VF) and composite nonarrhythmic death (pump failure death or heart transplant) served as competing outcomes. Results Over a median follow‐up of 2.4 years, 26 patients (4.6% per person‐year of follow‐up) developed FVT/VF with ICD shock, and 35 (6.3% per person‐year of follow‐up) had nonarrhythmic death. In competing risk analysis, after adjustment for demographics, left ventricular ejection fraction, New York Heart Association class, cardiomyopathy type, use of class I antiarrhythmics, and diabetes, increased percentage of VV′ alternans triplets ( 〉 69%) was associated with nonarrhythmic death (subhazard ratio [SHR] 2.09; 95% confidence interval [CI] 1.03–4.23; P = 0.041), rather than with FVT/VF (SHR 1.05; 95% CI 0.45–2.46; P = 0.901). Risk of nonarrhythmic death was especially high in diabetics with VV′ alternans triplets in the highest quartile (SHR 3.46; 95% CI 1.41–8.50; P = 0.007). Conclusion In ICD patients with structural heart disease sinus VV′ alternans triplets on NF EGM is independently associated with nonarrhythmic death, rather than with FVT/VF.
Type of Medium:
Online Resource
ISSN:
0147-8389
,
1540-8159
DOI:
10.1111/pace.2015.38.issue-5
Language:
English
Publisher:
Wiley
Publication Date:
2015
detail.hit.zdb_id:
2037547-5
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