Document Detail


Predictors of appropriate defibrillator therapy among patients with an implantable defibrillator that delivers cardiac resynchronization therapy.
MedLine Citation:
PMID:  16684019     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTRODUCTION: The purpose of this study was to determine predictors of appropriate implantable defibrillator (ICD) therapy among patients with heart failure who are treated with a cardiac resynchronization therapy-defibrillator (CRT-D). METHODS AND RESULTS: Patients enrolled in the Ventak CHF/Contak CD study were treated with a CRT-D device and were required to have NYHA class II-IV CHF, QRS duration > or = 120 msec, and a class I or II indication for an ICD. The study database was retrospectively analyzed during the 6-month postimplant period to identify predictors of appropriate ICD therapy. Five hundred and one of the 581 patients enrolled in the trial had successful device implantation and were included in this analysis. Patients were mostly male (83%), 66 +/- 11 years old, and had coronary artery disease (69%), a mean left ventricular ejection fraction (EF) = 0.22 +/- 0.07, and NYHA class II (33%), III (58%), or IV (9%) CHF symptoms. During 6 months of follow-up, 73 of 501 (14%) patients received an appropriate ICD therapy. Two independent predictors of appropriate therapy were identified: a history of a spontaneous, sustained ventricular arrhythmia (HR = 2.05; 95% CI = 1.31-3.20; P = 0.002) and NYHA class IV CHF (HR = 1.81; 95% CI = 1.10-2.96; P = 0.019). When patients with NYHA class II were excluded from analysis, a history of a sustained ventricular arrhythmia and the presence of NYHA class IV CHF symptoms remained as independent predictors of appropriate ICD therapy. CONCLUSIONS: In a select population of advanced heart failure patients receiving a CRT-D, NYHA class IV CHF was a powerful independent predictor of appropriate ICD therapy. Approximately one-quarter of the patients with NYHA class IV CHF who received a CRT-D device received an appropriate ICD therapy within 3 months after implant. Additional studies are needed to confirm an association between class IV CHF symptoms and an increased frequency of ICD shocks.
Authors:
Aseem D Desai; Martin C Burke; Thomas E Hong; Susan Kim; Yasser Salem; Patrick G Yong; Bradley P Knight
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  17     ISSN:  1045-3873     ISO Abbreviation:  J. Cardiovasc. Electrophysiol.     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-05-10     Completed Date:  2006-10-12     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  486-90     Citation Subset:  IM    
Affiliation:
Section of Cardiology, Department of Internal Medicine, University of Chicago, Chicago, Illinois 60637, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Arrhythmias, Cardiac / epidemiology*,  prevention & control*
Cardiac Pacing, Artificial / statistics & numerical data*
Comorbidity
Defibrillators, Implantable / statistics & numerical data
Disease-Free Survival
Double-Blind Method
Electric Countershock / statistics & numerical data*
Female
Heart Failure / epidemiology*,  therapy*
Humans
Male
Prognosis
Risk Assessment / methods*
Risk Factors
Treatment Outcome
United States / epidemiology
Comments/Corrections
Comment In:
J Cardiovasc Electrophysiol. 2006 May;17(5):491-4   [PMID:  16684020 ]

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


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