Document Detail

Heart failure and the risk of shocks in patients with implantable cardioverter defibrillators: results from the Triggers Of Ventricular Arrhythmias (TOVA) study.
MedLine Citation:
PMID:  14993132     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Left ventricular ejection fraction (LVEF) predicts device discharges in patients with implantable cardioverter-defibrillators (ICDs). The relationship between severity of congestive heart failure (CHF) and ICD discharges is less clear. METHODS AND RESULTS: We prospectively analyzed the association between CHF and risk of appropriate ICD discharges in the Triggers Of Ventricular Arrhythmias (TOVA) study, a cohort study of ICD patients conducted at 31 centers in the United States. Reported shocks were confirmed for sustained ventricular tachycardia (VT) or fibrillation (VF) by analysis of stored electrograms. Proportional hazards models included CHF categorized by New York Heart Association class. Baseline CHF was present among 502 (44%) of 1140 patients; 170 (34%) had class I, 230 (46%) had class II, 97 (19%) had class III, and only 5 (1%) had class IV symptoms. During median follow-up of 212 days, 92 patients experienced 1 or more appropriate ICD discharges. Class III CHF was associated in a statistically significantly manner with ICD discharge for VT/VF (hazard ratio 2.40, 95% CI 1.16 to 4.98), even with adjustment for LVEF. The combination of LVEF <0.20 and class III symptoms resulted in a particularly high risk of shocks for VT/VF (hazard ratio 3.90, 95% CI 1.28 to 11.92). CONCLUSIONS: Class III CHF, an easily accessible clinical measure, is an independent risk factor, along with LVEF, for ventricular arrhythmias that require shock therapy among ICD patients. Whether patients with class III CHF benefit to a greater degree from ICDs and whether aggressive treatment of CHF in ICD patients may prevent ventricular arrhythmias remains to be determined.
William Whang; Murray A Mittleman; David Q Rich; Paul J Wang; Jeremy N Ruskin; Geoffrey H Tofler; James E Muller; Christine M Albert;
Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.     Date:  2004-03-01
Journal Detail:
Title:  Circulation     Volume:  109     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-23     Completed Date:  2004-07-08     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1386-91     Citation Subset:  AIM; IM    
Cardiovascular Division, Bulfinch 001, Massachusetts General Hospital, 55 Fruit St, Boston, Mass 02114, USA.
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MeSH Terms
Actuarial Analysis
Cardiovascular Agents / therapeutic use
Death, Sudden, Cardiac / prevention & control
Defibrillators, Implantable* / statistics & numerical data*
Disease-Free Survival
Electric Countershock / statistics & numerical data*
Follow-Up Studies
Heart Failure / complications*,  drug therapy
Middle Aged
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
Risk Factors
Severity of Illness Index
Stroke Volume*
Tachycardia, Ventricular / epidemiology*,  etiology,  prevention & control,  therapy
United States / epidemiology
Ventricular Fibrillation / epidemiology*,  etiology,  prevention & control,  therapy
Grant Support
Reg. No./Substance:
0/Cardiovascular Agents

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