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Risk of ventricular tachyarrhythmias following improvement of left ventricular ejection fraction in patients with implantable cardiac defibrillators implanted for primary prevention of sudden cardiac death

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

In patients who undergo implantable cardiac defibrillator (ICD) implantation for primary prevention of sudden cardiac death (SCD), data is unclear whether their ICD generator needs to be replaced at end of life if their left ventricular ejection fraction (EF) improves. Despite improvement in EF, the underlying scar may represent a potential substrate for ventricular arrhythmias.

Methods

Data on 280 patients who underwent ICD implantation for primary prevention of SCD was obtained from two centers. Patients were followed for any improvement in EF to ≥35%. All arrhythmic events during follow-up, including appropriate and inappropriate shocks/ATP, were recorded.

Results

Thirty percent (n = 86/280) of patients improved their EF to >35% of which 41% (n = 37) underwent a generator change by the study ending period with the rest not yet at ERI. Mean baseline EF in patients with and without target EF improvement was 26 ± 7 and 23 ± 7% (p = 0.2). After excluding patients whose arrhythmic events data were unavailable, the final sample consisted of 62 patients in the EF improvement group and 156 patients in the group without EF improvement. In the group with EF improvement, appropriate events (shock + ATP) were noted in 19% of patients (n = 12/62) and inappropriate shocks and ATP in 6% of (n = 4/62) patients after their EF improved to >35%. Four patients received appropriate therapies when their EF was low prior to improvement. In contrast, in patients who had no improvement in EF, 27% (n = 43/156) received an appropriate therapy (p = 0.6) while 11% (n = 18/156) (p = 0.2) received inappropriate shocks and ATP. All-cause mortality was higher in patients without subsequent improvement in EF versus those with EF improvement (31 vs. 15% (p = .005).

Conclusions

There was no significant difference in the number of appropriate therapies received by each group. Patients continue to be at high risk for sudden cardiac death despite improvement in EF.

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Abbreviations

SCD:

Sudden cardiac death

ICD:

Implantable cardioverter defibrillator

EF:

Ejection fraction

CRTD:

Cardiac resynchronization therapy device

ERI:

Elective replacement indicator

EOL:

End of life

ATP:

Anti-tachycardia pacing

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Acknowledgements

Part of the material in this manuscript is the result of work supported with resources and the use of facilities at the Robley Rex VA Medical Center in Louisville, KY

Author contributions

Jayasree Pillarisetti—idea, concept, design, data analysis, manuscript preparation

Rakesh Gopinathannair—design, critical revision of article

Matthew J. Haney—data collection

Bassem Abazid - Data collection

Wasiq Rawasia—data collection

Madhu Yeruva Reddy—critical revision of article

Niveditha Adabala—data collection

Sudharani Bommana—database administration

Martin Emert—critical review of article

Dhanunjaya Lakkireddy—critical review of article, approval of article

Author information

Authors and Affiliations

  1. Division of Cardiology, University of Kansas Hospital, Kansas City, KS, USA

    Jayasree Pillarisetti, Madhu Yeruva Reddy, Niveditha Adabala, Sudharani Bommana, Martin Emert & Dhanunjaya Lakkireddy

  2. University of Kansas Medical Center and Hospital, 3901, Rainbow Blvd; G-600, Kansas City, KS, 66196, USA

    Jayasree Pillarisetti, Madhu Yeruva Reddy, Niveditha Adabala, Sudharani Bommana, Martin Emert & Dhanunjaya Lakkireddy

  3. Division of Cardiovascular Medicine, Robley Rex VA Medical Center and University of Louisville School of Medicine, Louisville, KY, USA

    Rakesh Gopinathannair, Matthew J. Haney, Bassem Abazid & Wasiq Rawasia

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  1. Jayasree Pillarisetti
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Correspondence to Jayasree Pillarisetti.

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Pillarisetti, J., Gopinathannair, R., Haney, M.J. et al. Risk of ventricular tachyarrhythmias following improvement of left ventricular ejection fraction in patients with implantable cardiac defibrillators implanted for primary prevention of sudden cardiac death. J Interv Card Electrophysiol 48, 283–289 (2017). https://doi.org/10.1007/s10840-017-0222-1

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  • DOI: https://doi.org/10.1007/s10840-017-0222-1

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