Prognostic impact of recurrences of ventricular tachyarrhythmias and appropriate ICD therapies in a high-risk ICD population

  • Tobias Schupp
  • Ibrahim Akin
  • Linda Reiser
  • Armin Bollow
  • Gabriel Taton
  • Thomas Reichelt
  • Dominik Ellguth
  • Niko Engelke
  • Uzair Ansari
  • Kambis Mashayekhi
  • Christel Weiß
  • Christoph Nienaber
  • Muharrem Akin
  • Martin Borggrefe
  • Michael BehnesEmail author
Original Paper



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.


Recurrences 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.

Supplementary material

392_2019_1416_MOESM1_ESM.docx (21 kb)
Supplementary material 1 (DOCX 21 KB)


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Copyright information

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

Authors and Affiliations

  • Tobias Schupp
    • 1
  • Ibrahim Akin
    • 1
  • Linda Reiser
    • 1
  • Armin Bollow
    • 1
  • Gabriel Taton
    • 1
  • Thomas Reichelt
    • 1
  • Dominik Ellguth
    • 1
  • Niko Engelke
    • 1
  • Uzair Ansari
    • 1
  • Kambis Mashayekhi
    • 2
  • Christel Weiß
    • 3
  • Christoph Nienaber
    • 4
  • Muharrem Akin
    • 5
  • Martin Borggrefe
    • 1
  • Michael Behnes
    • 1
    Email author
  1. 1.First Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHKUniversity Medical Centre Mannheim (UMM), University of Heidelberg, German Center for Cardiovascular Research) partner site Heidelberg/MannheimMannheimGermany
  2. 2.Department of Cardiology and Angiology IIUniversity Heart Center Freiburg Bad KrozingenBad KrozingenGermany
  3. 3.Institute of Biomathematics and Medical Statistics, Faculty of Medicine MannheimUniversity Medical Center Mannheim (UMM), Heidelberg UniversityMannheimGermany
  4. 4.Royal Brompton and Harefield Hospitals, NHSLondonUK
  5. 5.Department of Cardiology and AngiologyHannover Medical SchoolHannoverGermany

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