Herzschrittmachertherapie + Elektrophysiologie

, Volume 22, Issue 4, pp 219–225

Predictors of sustained ventricular arrhythmia episodes in patients with primary ICD indication

Male gender and AF in primary ICD prophylaxis
  • T. Deneke
  • T. Lawo
  • J. Reinecke
  • C. Buttler
  • P.H. Grewe
  • D.-I. Shin
  • B. Gerritse
  • A. Mügge
  • B. Lemke
  • A. Kloppe
Originalarbeit
  • 77 Downloads

Abstract

Aims

Implantable cardioverter–defibrillators (ICD) reduce mortality in patients with severely impaired left ventricular function. In randomized studies, female patients are underrepresented and data on ICD therapy is limited. Atrial fibrillation (AF) is a determinant of poor prognosis but has not been consistently evaluated. We evaluated the risk factors for the occurrence of ventricular arrhythmia episodes in patients with primary ICD prophylaxis.

Methods

Consecutive patients after ICD implantation for primary prophylaxis were followed. During follow-up, detected sustained episodes of ventricular arrhythmia were documented. Multivariate analysis controlled for propensity score was used to evaluate the correlation between gender, history of AF, and the occurrence of ventricular arrhythmia episodes.

Results

A total of 400 patients (19.8% female; n = 79) were included. During follow-up, 64 patients (16%) had appropriate ICD therapy episodes. Men (18%) had significantly more often episodes than women (8%; p = 0.025). Patients with a history of AF (102, 25.5%) had significantly more often episodes (30%) compared to patients without a history of AF (11%; p < 0.001). In a multivariate model, only gender (p = 0.02) and history of AF (p < 0.001) were significantly associated predictors of the occurrence of appropriate ICD therapies during follow-up. Based on the propensity score model, the adjusted hazard ratio for male gender was 2.7 (p = 0.02) and 2.6 (p = 0.0004) for history of AF.

Conclusion

Male gender and history of AF are independent predictors for the occurrence of sustained ventricular arrhythmia in primary ICD prophylaxis. Further studies need to evaluate whether history of AF in female patients might be an indicator for higher risk of sudden cardiac arrhythmic death.

Keywords

Gender differences Primary prevention Implantable cardioverter–defibrillator Atrial fibrillation Ventricular arrhythmia 

Prädiktoren anhaltender ventrikulärer Arrhythmieepisoden bei Patienten mit primärer ICD-Indikation

Männliches Geschlecht und Vorhofflimmern bei der ICD-Primärprävention

Zusammenfassung

Ziele

Bei deutlich eingeschränkter linksventrikulärer Funktion verringert die Implantation eines Kardioverter-Defibrillators (ICD) die Mortalität. In randomisierten Studien sind Frauen unterrepräsentiert, ferner sind Daten zur ICD-Therapie limitiert. Wir evaluierten Risikofaktoren für das Auftreten ventrikulärer Arrhythmieepisoden bei Patienten mit primärer ICD-Prophylaxe.

Methoden

Beobachtet wurden konsekutive Patienten nach ICD-Implantation mit der Indikation Primärprophylaxe. Während der Follow-up-Periode diagnostizierte anhaltende Episoden ventrikulärer Arrhythmien wurden dokumentiert. Mithilfe einer multivariaten Analyse unter Berücksichtigung des Propensity Score wurden Korrelationen zwischen Geschlecht, VF in der Anamnese und ventrikulären Arrhythmieepisoden überprüft.

Ergebnisse

Insgesamt 400 Patienten (19,8% weiblich; n = 79) wurden aufgenommen. Während der Follow-up-Periode hatten 64 (16%) Patienten entsprechende ICD-Behandlungsepisoden. Männer hatten signifikant häufiger (18%) Episoden als Frauen (8%; p = 0,025), ebenso Patienten mit AF in der Anamnese (n=102, 25,5%) im Vergleich mit denen ohne AF in der Vorgeschichte (30 vs. 11%; p < 0,001). In einem multivariaten Modell erwiesen sich lediglich Geschlecht (p = 0,02) und AF in der Anamnese (p < 0,001) als signifikant assoziierte Prädiktoren für das Auftreten von ICD-Behandlungen wärend der Follow-up-Periode. Auf der Grundlage des Propensity-Score-Modells lag die adjustierte Hazard Ratio für den Faktor männliches Geschlecht bei 2,7 (p = 0,02) und für den Faktor AF in der Anamnese bei 2,6 (p = 0,0004).

Zusammenfassung

Männliches Geschlecht und AF in der Anamnese sind unabhängige Prädiktoren für das Auftreten anhaltender ventrikulärer Arrhythmien bei der primären ICD-Prophylaxe. In weiteren Studien sollte AF als möglicher Risikoindikator für einen plötzlichen Herztod bei Frauen überprüft werden.

Schlüsselwörter

Geschlechtsspezifische Unterschiede Primärprävention  Implantiertbarer Kardioverter-Defibrillator Vorhofflimmern Ventrikuläre Arrhythmie 

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • T. Deneke
    • 1
    • 2
  • T. Lawo
    • 1
  • J. Reinecke
    • 1
  • C. Buttler
    • 1
  • P.H. Grewe
    • 1
  • D.-I. Shin
    • 3
  • B. Gerritse
    • 4
  • A. Mügge
    • 1
  • B. Lemke
    • 1
  • A. Kloppe
    • 1
  1. 1.University Heart Center Bergmannsheil BochumBochumGermany
  2. 2.Heart Center Bad NeustadtBad NeustadtGermany
  3. 3.Academic Heart Center CologneCologneGermany
  4. 4.Bakken Research Institute for Clinical Statistics, Medtronic, MaastrichtMaastrichtThe Netherlands

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