Document Detail


Differences in effects of electrical therapy type for ventricular arrhythmias on mortality in implantable cardioverter-defibrillator patients.
MedLine Citation:
PMID:  20185109     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Implantable cardioverter-defibrillator (ICD) shocks have been associated with an increased risk of death. It is unknown whether this is due to the ventricular arrhythmia (VA) or shocks and whether antitachycardia pacing (ATP) termination can reduce this risk. OBJECTIVE: The purpose of this study was to determine whether mortality in ICD patients is influenced by the type of therapy (shocks of ATP) delivered. METHODS: Cox models evaluated effects of baseline characteristics, ventricular tachycardia (VT; <188 bpm), fast VT (FVT; 188-250 bpm), ventricular fibrillation (VF; >250 bpm), and therapy type (shocks or ATP) on mortality among 2135 patients in four trials of ATP to reduce shocks. RESULTS: Over 10.8 +/- 3.3 months, 24.3% patients received appropriate shocks (50.6%) or ATP only (49.4%), and 6.6% died. Mortality predictors were age (hazard ratio 1.07, 95% confidence interval 1.04-1.08, P <.0001), New York Heart Association class III/IV (3.50 [2.27-5.41]; P <.0001), coronary disease (3.08 [1.31-7.25]; P = .01), and cumulative VA (VT + FVT + VF) episodes shocked (1.20 [1.13, 1.29]; P <.0001). Beta-blockers (0.65, 0.46-0.92; P <.0001) and remote myocardial infarction (0.53, [0.38-0.76] P = .0004) predicted reduced risk. Since 92% of VT and all VF received a single therapy type (ATP and shocks, respectively), the effect of therapy on episode risk could not be established. For FVT (32% shocked, 68% ATP), episode and therapy effects could be uncoupled; ATP-terminated FVT did not increase episode mortality risk, whereas shocked FVT increased risk by 32%. Survival rates were highest among patients with no VA (93.8%) of ATP-only (94.7%) and lowest for shocked patients (88.4%). Monthly episode rates were 80% higher among shocked versus ATP-only patients. CONCLUSIONS: Shocked VA episodes are associated with increased mortality risk. Shocked patients have substantially higher VA episode burden and poorer survival compared with ATP-only-treated patients.
Authors:
Michael O Sweeney; Lou Sherfesee; Paul J DeGroot; Mark S Wathen; Bruce L Wilkoff
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2009-12-02
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  7     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-02-26     Completed Date:  2010-06-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  353-60     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Affiliation:
Cardiac Arrhythmia Service, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. mosweeney@partners.org
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac Pacing, Artificial / methods*,  mortality
Defibrillators, Implantable*
Female
Humans
Intensive Care Units
Male
Middle Aged
Proportional Hazards Models
Tachycardia, Ventricular / mortality*,  therapy*
Ventricular Fibrillation / mortality*,  therapy*
Comments/Corrections
Comment In:
Heart Rhythm. 2010 Mar;7(3):361-2   [PMID:  20185110 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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