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.
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.
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References
Bardy GH, Lee KL, Mark DB et al (2005) Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 352:225–237
Kadish A, Dyer A, Daubert JP et al (2004) Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med 350:2151–2158
Moss AJ, Zareba W, Hall WJ et al (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 346:877–883
Buxton AE, Lee KL, Fisher JD et al (1999) A randomized study of the prevention of sudden death in patients with coronary artery disease. N Engl J Med 341:1882–1890
Saxon LA, Bristow MR, Boehmer J et al (2006) Predictors of sudden cardiac death and appropriate shock in the comparison of medical therapy, pacing, and defibrillation in heart failure (COMPANION) trial. Circulation 114:2766–2772
Daubert JP, Zareba W, Cannom DS et al (2008) Inappropriate implantable cardioverter-defibrillator shocks in MADIT II. frequency, mechanisms, predictors, and survival impact. J Am Coll Cardiol 51:1357–1365
Russo AM, Stamato NJ, Lehmann MH et al (2004) Influence of gender on arrhythmia characteristics and outcome in the Multicenter UnSustained Tachycardia Trial. J Cardiovasc Electrophysiol 15:993–998
Chen HA, Hsia HH, Vagelos R et al (2007) The effect of gender on mortality or appropriate shock in patients with nonischemic cardiomyopathy who have implantable cardioverter-defibrillators. Pacing Clin Electrophysiol 30:390–394
Yarnoz MJ, Curtis AB (2006) Sex-based differences in cardiac resynchronization therapy and implantable cardioverter defibrillator therapies. Effectiveness and use. Cardiol Rev 14:292–298
Curtis LH, Al-Khatib SM, Shea AM et al (2007) Sex differences in the use of implantable cardioverter-defibrillators for primary and secondary prevention of sudden cardiac death. JAMA 298:1517–1524
Hernandez AF, Fonarow GC, Liang L et al (2007) Sex and racial differences in the use of implantable cardioverter-defibrillators among patients hospitalized with heart failure. JAMA 198:1525–1543
Horton HL, Marinchak RA, Rials SJ, Kowey PR (1995) Gender differences in device therapy for malignant vetnricular arrhythmias. Arch Intern Med 155:2324–2345
Villareal RP, Woodruff AL, Massumi A (2001) Gender and cardiac arrhythmias. Tex Heart Inst J 28:265–275
Deneke T, Mügge A, Müller P, Groot JR de (2009) Therapeutic implications of gender differences in supraventricular cardiac arrhythmias: lessons of life cannot be learned in a day. Expert Rev Cardiovasc Ther 7:879–882
Haigney MC, Zarebra W, Nasir JM (2009) Gender differences and risk of ventricular tachycardia or ventricular fibrillation. Heart Rhythm 6:180–186
Deneke T, Lawo T, Gerritse B et al (2004) Mortality of patients with implanted cardioverter defibrillators in relation to episodes of atrial fibrillation. Europace 6:151–158
Hohnloser SH, Crijns HJGM, Eickels M van et al (2009) Effect of dronedarone on cardiovascular events in atrial fibrillation. N Engl J Med 360:668–678
Klein G, Lissel C, Fusch A-C et al (2006) Predictors of VT/VF-occurrence in ICD-patients: results from the PROFIT-study. Europace 8:618–624
Grönefeld GC, Mauss O, Li Y-G et al (2000) Association between atrial fibrillation and appropriate implantable cardioverter defibrillator therapy: results from a prospective study. J Cardiovasc Electrophysiol 11:1208–1214
Smit MD, Van Dessel PF, Rienstra M et al (2006) Atrial fibrillation predicts appropriate shocks in primary prevention implantable cardioverter-defibrillator patients. Europace 8:566–572
Grunkemeier GL, Payne N, Jin R, Handy JR (2002) Propensity score analysis of stroke after off-pump coronary artery bypass grafting. Ann Thorac Surg 74:301–305
Joffe MM, Rosenbaum PR (1999) Invited commentary: propensity scores. Am J Epidemiol 150:327–333
Freedman RA, Swerdlow CD, Soderholm-Difatte V, Mason JW (1988) Clinical predictors of arrhythmia inducibility in survivors of cardiac arrest: importance of gender and prior myocardial infarction. J Am Coll Cardiol 12:973–978
Vaitkus PT, Kindwall KE, Miller JM et al (1991) Influence of gender on inducibility of ventricular arrhythmias in survivors of cardiac arrest with coronary artery disease. Am J Cardiol 67:537–539
Lampert R, McPherson CA, Clancy JF et al (2004) Gender differences in ventricular arrhythmia recurrence in patients with coronary artery disease and implantable cardioverter-defibrillators. J Am Coll Cardiol 43:2293–2299
Ghanbari H, Dalloul G, Hasan R et al (2009) Effectiveness of implantable cardioverter-defibrillators for the primary prevention of sudden cardiac death in women with advanced heart failure. Arch Intern Med 169:1500–1506
Hernandez AF, Fonarow GC, Hammil BG et al (2010) Clinical effectiveness of implantable cardioverter-defibrillators among medicare beneficiaries with heart failure. Circ Heart Fail 3:7–13
Bursi F, Eston SA, Redfield MM et al (2006) Systolic and diastolic heart failure in the community. JAMA 296:2209–2216
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Deneke, T., Lawo, T., Reinecke, J. et al. Predictors of sustained ventricular arrhythmia episodes in patients with primary ICD indication. Herzschr. Elektrophys. 22, 219–225 (2011). https://doi.org/10.1007/s00399-011-0152-z
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DOI: https://doi.org/10.1007/s00399-011-0152-z
Keywords
- Gender differences
- Primary prevention
- Implantable cardioverter–defibrillator
- Atrial fibrillation
- Ventricular arrhythmia