Document Detail


Ventricular arrhythmia storms in postinfarction patients with implantable defibrillators for primary prevention indications: a MADIT-II substudy.
MedLine Citation:
PMID:  17954398     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Much of prognostic implications of ventricular arrhythmia storms remain unclear. OBJECTIVE: We evaluated the risk associated with electrical storm in patients with defibrillators in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II) study. METHODS: Electrical storm was defined as > or =3 episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) in 24 hours. RESULTS: Of the 719 patients who received internal cardiac defibrillator (ICD) implants and had follow-up in the MADIT-II, 27 patients (4%) had electrical storm, 142 (20%) had isolated episodes of VT/VF, and the remaining 550 patients had no ICD-recorded VT events. Baseline clinical characteristics among the groups were similar. Patients who experienced electrical storm had a significantly higher risk of death. After adjustments for relevant clinical covariates, the hazard ratio (HR) for death in the first 3 months after the storm event was 17.8 (95% confidence interval [CI] 8.0 to 39.5, P <.01) in comparison with those with no VT/VF. This risk continued even after 3 months for those with electrical storm (HR of 3.5, 95% CI 1.2 to 9.8, P = .02). Study patients with isolated VT/VF episodes also were at an increased risk of dying (HR = 2.5, 95% CI 1.5 to 4.0, P <.01) when compared with patients without VT/VF episodes. Statistically significant predictors of electrical storm were interim postenrollment coronary events (myocardial infarction or angina) HR 3.1 (95% CI 1.2 to 8.1, P = .02) and isolated VT or VF HR 9.2 (95% CI 4.0 to 20.9, P <.01). CONCLUSION: Postinfarction patients with severe left ventricular dysfunction in whom electrical storm developed have significantly higher mortality than patients with only isolated VT/VF as well as those without any episodes of VT/VF. Patients who experienced postenrollment ventricular arrhythmias and/or interim coronary events during follow-up were at higher risk for VT/VF storms.
Authors:
Henry W Sesselberg; Arthur J Moss; Scott McNitt; Wojciech Zareba; James P Daubert; Mark L Andrews; W Jackson Hall; Benjamin McClinitic; David T Huang;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-07-17
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  4     ISSN:  1547-5271     ISO Abbreviation:  Heart Rhythm     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-10-23     Completed Date:  2008-02-08     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1395-402     Citation Subset:  IM    
Affiliation:
Department of Medicine, Cardiology Unit, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Defibrillators, Implantable*
Female
Heart Failure
Humans
Male
Middle Aged
Myocardial Infarction / complications,  physiopathology*
Primary Prevention*
Prospective Studies
Risk Factors
Stroke Volume
Tachycardia, Ventricular / etiology*,  prevention & control
Time Factors
Ventricular Fibrillation / etiology*,  prevention & control

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


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