Document Detail


Role of implantable cardioverter defibrillator therapy in patients with acquired long QT syndrome: a long-term follow-up.
MedLine Citation:
PMID:  21979994     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: The use of implantable cardioverter defibrillators (ICD) in patients with torsade de pointes (TdP) and ventricular fibrillation in the presence of acquired long QT syndrome (aLQTS) is under debate, partly due to the fact that aLQTS is potentially reversible and currently no long-term follow-up data are available. We aimed to evaluate the long-term follow-up of patients with acquired long QT syndrome (aLQTS) who had received an implantable cardioverter defibrillator (ICD) for secondary prevention of sudden cardiac arrest (SCA).
METHOD AND RESULTS: Over a 10 year period, 43 patients with an ICD after survived cardiac arrest (SCA) due to an aLQTS were included [female n= 27 (63%); mean age 61 ± 16 years]. There was no clinical evidence for congenital LQTS (Schwartz score 1.25 ± 0.8). Structural heart disease was present in 29 patients (47%; ischaemic n= 13; dilated cardiomyopathy n= 9; mean EF 41%± 12). The most common proarrhythmic trigger happened to be antiarrhythmic drugs (n= 34; 79%). Other triggers included contrast agent (n= 1), haloperidol (n= 2), severe hypokalaemia (n= 2), drug abuse/alcohol (n= 2), and mere severe bradycardia (n= 2). Under trigger QTc interval measured 536 ± 58 vs. 438 ± 33 ms without trigger (P< 0.001). During a mean follow-up of 84 ± 55 months, appropriate shocks occurred in 19 patients (44%); inappropriate shocks in 13 patients (30%; only inappropriate n= 3). Appropriate shocks were almost as common in patients without as in those with structural heart disease (35 vs. 48%; P= 0.32). None of the patients were re-exposed to the initial trigger during the follow-up period. Beta-blocker medication did not prevent ICD shocks (12 of 19 vs. 11 of 24 on medication). ConcluSION: Appropriate ICD shocks are a common finding in patients with aLQTS and SCA irrespective of the underlying cause or structural heart disease. Thus, even in the presence of relevant acquired proarrhythmia ICD may be beneficial.
Authors:
Gerold Mönnig; Julia Köbe; Andreas Löher; Kristina Wasmer; Peter Milberg; Stephan Zellerhoff; Christian Pott; Sven Zumhagen; Razvan Radu; Hans H Scheld; Wilhelm Haverkamp; Eric Schulze-Bahr; Lars Eckardt
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-10-06
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  14     ISSN:  1532-2092     ISO Abbreviation:  Europace     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-22     Completed Date:  2012-07-11     Revised Date:  2013-05-20    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  England    
Other Details:
Languages:  eng     Pagination:  396-401     Citation Subset:  IM    
Affiliation:
Department of Cardiology and Angiology, Division of Experimental and Clinical Electrophysiology, University Hospital Münster, Münster, Germany. moennig@uni-muenster.de
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use
Adult
Aged
Anti-Arrhythmia Agents / therapeutic use
Death, Sudden, Cardiac / prevention & control
Defibrillators, Implantable*
Female
Follow-Up Studies
Heart Diseases / therapy
Humans
Long QT Syndrome / drug therapy,  therapy*
Male
Middle Aged
Prospective Studies
Retrospective Studies
Treatment Outcome
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Anti-Arrhythmia Agents
Comments/Corrections
Comment In:
Europace. 2012 Mar;14(3):310-1   [PMID:  22106361 ]

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


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