Advertisement

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

Abstract

Purpose

The study sought to evaluate the prognostic impact of recurrences of ventricular tachyarrhythmias in consecutive ICD recipients with ventricular tachyarrhythmias on admission.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Recurrences Ventricular tachyarrhythmia Ventricular tachycardia Ventricular fibrillation ICD Mortality 

Notes

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)

References

  1. 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. 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. 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
  4. 4.
    Voss F, Schueler M, Lauterbach M, Bauer A, Katus HA, Becker R (2016) Safety of symptom-limited exercise testing in a big cohort of a modern ICD population. Clin Res Cardiol 105:53–58CrossRefGoogle Scholar
  5. 5.
    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 337:1576–1583CrossRefGoogle Scholar
  6. 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
  7. 7.
    Lachmann V, Makimoto H, Kelm M, Bonner F (2017) Aborted sudden cardiac death: ICD or no ICD. Clin Res Cardiol 106:760–763CrossRefGoogle Scholar
  8. 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
  9. 9.
    Miyazawa K, Kondo Y, Ueda M, Kajiyama T, Nakano M, Inagaki M, Schwab JO, Sears SF, Kobayashi Y (2018) Prospective survey of implantable defibrillator shock anxiety in Japanese patients: results from the DEF-Chiba study. Pacing Clin Electrophysiol PACE 41:1171–1177CrossRefGoogle Scholar
  10. 10.
    Karaoguz R, Maydanozcu S, Altun T, Guldal M, Akyurek O, Erol C (2006) Appropriate ICD therapy in patients with idiopathic dilated cardiomyopathy: long term follow-up. Int Heart J 47:763–773CrossRefGoogle Scholar
  11. 11.
    Grimm W, Flores BT, Marchlinski FE (1993) Shock occurrence and survival in 241 patients with implantable cardioverter-defibrillator therapy. Circulation 87:1880–1888CrossRefGoogle Scholar
  12. 12.
    Qian Z, Zhang Z, Guo J, Wang Y, Hou X, Feng G, Zou J (2016) Association of implantable cardioverter defibrillator therapy with all-cause mortality-a systematic review and meta-analysis. Pacing Clin Electrophysiol PACE 39:81–88CrossRefGoogle Scholar
  13. 13.
    Larsen GK, Evans J, Lambert WE, Chen Y, Raitt MH (2011) Shocks burden and increased mortality in implantable cardioverter-defibrillator patients. Heart Rhythm 8:1881–1886CrossRefGoogle Scholar
  14. 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
  15. 15.
    Santini M, Lavalle C, Ricci RP (2007) Primary and secondary prevention of sudden cardiac death: who should get an ICD? Heart 93:1478–1483CrossRefGoogle Scholar
  16. 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. 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
  18. 18.
    Deneke T, Israel CW, Krug J, Nentwich K, Müller P, Mügge A, Schade A (2013) Indikationen zur Katheterablation bei ventrikulärer Tachykardie. Dtsch med Wochenschr 138:1952–1956CrossRefGoogle Scholar
  19. 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
  20. 20.
    Ferdinand D, Otto M, Weiss C (2016) Get the most from your data: a propensity score model comparison on real-life data. Int J Gen Med 9:123–131CrossRefGoogle Scholar
  21. 21.
    Austin PC (2011) An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 46:399–424CrossRefGoogle Scholar
  22. 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
  23. 23.
    Pacifico A, Ferlic LL, Cedillo-Salazar FR, Nasir N Jr, Doyle TK, Henry PD (1999) Shocks as predictors of survival in patients with implantable cardioverter-defibrillators. J Am Coll Cardiol 34:204–210CrossRefGoogle Scholar
  24. 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
  25. 25.
    Bettin M, Rath B, Ellermann C, Leitz P, Reinke F, Kobe J, Eckardt L, Frommeyer G (2018) Follow-up of the first patients with a totally subcutaneous ICD in Germany from implantation till battery depletion. Clin Res Cardiol 108:16–21CrossRefGoogle Scholar
  26. 26.
    Halbfass P, Sonne K, Nentwich K, Ene E, Deneke T (2018) Current developments in cardiac rhythm management devices. Clin Res Cardiol 107:100–104CrossRefGoogle Scholar
  27. 27.
    Bettin M, Dechering D, Frommeyer G, Larbig R, Loher A, Reinke F, Kobe J, Eckardt L (2018) Right versus left parasternal electrode position in the entirely subcutaneous ICD. Clin Res Cardiol 107:389–394CrossRefGoogle Scholar
  28. 28.
    Frommeyer G, Dechering DG, Zumhagen S, Loher A, Kobe J, Eckardt L, Reinke F (2016) Long-term follow-up of subcutaneous ICD systems in patients with hypertrophic cardiomyopathy: a single-center experience. Clin Res Cardiol 105:89–93CrossRefGoogle Scholar
  29. 29.
    Kobe J, Hucklenbroich K, Geisendorfer N, Bettin M, Frommeyer G, Reinke F, Dechering D, Burgmer M, Eckardt L (2017) Posttraumatic stress and quality of life with the totally subcutaneous compared to conventional cardioverter-defibrillator systems. Clin Res Cardiol 106:317–321CrossRefGoogle Scholar
  30. 30.
    Erath JW, Vamos M, Sirat AS, Hohnloser SH (2017) The wearable cardioverter-defibrillator in a real-world clinical setting: experience in 102 consecutive patients. Clin Res Cardiol 106:300–306CrossRefGoogle Scholar
  31. 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. 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
  33. 33.
    Luedde M, Spehlmann ME, Frey N (2018) Progress in heart failure treatment in Germany. Clin Res Cardiol 107:105–113CrossRefGoogle Scholar
  34. 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
  35. 35.
    Omran H, Bitter T, Horstkotte D, Oldenburg O, Fox H (2018) Characteristics and circadian distribution of cardiac arrhythmias in patients with heart failure and sleep-disordered breathing. Clin Res Cardiol 107:965–974CrossRefGoogle Scholar
  36. 36.
    Dinshaw L, Munch J, Dickow J, Lezius S, Willems S, Hoffmann BA, Patten M (2018) The T-peak-to-T-end interval: a novel ECG marker for ventricular arrhythmia and appropriate ICD therapy in patients with hypertrophic cardiomyopathy. Clin Res Cardiol 107:130–137CrossRefGoogle Scholar
  37. 37.
    Pastori D, Miyazawa K, Li Y, Shahid F, Hado H, Lip GYH (2018) Inflammation and the risk of atrial high-rate episodes (AHREs) in patients with cardiac implantable electronic devices. Clin Res Cardiol 107:772–777CrossRefGoogle Scholar
  38. 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. 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. 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
  41. 41.
    Fang CY, Chen HC, Chen YL, Tsai TH, Pan KL, Lin YS, Chen MC, Lee WC (2018) Comparison of ventricular tachyarrhythmia recurrence between ischemic cardiomyopathy and dilated cardiomyopathy: a retrospective study. Peer J 6:e5312CrossRefGoogle Scholar
  42. 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
  43. 43.
    Chao TF, Liu CJ, Tuan TC, Chen SJ, Chen TJ, Lip GYH, Chen SA (2017) Risk and prediction of sudden cardiac death and ventricular arrhythmias for patients with atrial fibrillation - a nationwide cohort study. Sci Rep 7:46445CrossRefGoogle Scholar
  44. 44.
    Myrstad M, Malmo V, Ulimoen SR, Tveit A, Loennechen JP (2018) Exercise in individuals with atrial fibrillation. Clin Res Cardiol.  https://doi.org/10.1007/s00392-018-1361-9 Google Scholar
  45. 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
  46. 46.
    Sramko M, Wichterle D, Melenovsky V, Franekova J, Clemens M, Fukunaga M, Kautzner J (2018) Independent effect of atrial fibrillation on natriuretic peptide release. Clin Res Cardiol.  https://doi.org/10.1007/s00392-018-1332-1 Google Scholar
  47. 47.
    Jobs A, Schwind J, Katalinic A, Babaev V, Tilz RR, Rausch S, Thiele H, Eitel I, Eitel C (2018) Prognostic significance of atrial fibrillation in acute decompensated heart failure with reduced versus preserved ejection fraction. Clin Res Cardiol 108:74–82CrossRefGoogle Scholar

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

Personalised recommendations