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Equivalent arrhythmic risk in patients recently diagnosed with dilated cardiomyopathy compared with patients

Kevin J Makati1, Airley E Fish, Hannah H England

  • 1Tufts University School of Medicine/New England Medical Center, Boston, Massachusetts 02111, USA. mlink@tufts-nemc.org

Heart Rhythm
|March 29, 2006
PubMed

Insights

The 9-month diagnosis duration for nonischemic dilated cardiomyopathy does not predict arrhythmic risk for implantable cardioverter-defibrillators (ICDs). Patients with recent or late diagnoses show similar rates of potentially lethal arrhythmias.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Centers for Medicare and Medicaid Services (CMS) expanded implantable cardioverter-defibrillator (ICD) coverage for nonischemic dilated cardiomyopathy (DCM) with a 9-month diagnosis duration criterion.
  • This study investigates the impact of this 9-month criterion on arrhythmic risk in patients with nonischemic DCM.

Purpose of the Study:

  • To analyze and compare the arrhythmic risk in patients with nonischemic DCM based on recent (<9 months) versus late (≥9 months) diagnosis.
  • To evaluate the efficacy of the 9-month diagnostic duration as a predictor of sudden cardiac death risk in this patient population.

Main Methods:

  • Analysis of an ICD registry from Tufts-New England Medical Center.
  • Division of 131 nonischemic DCM patients into two cohorts: recent (<9 months) and late (≥9 months) diagnosis.
  • Assessment of treated ventricular arrhythmias, potentially lethal arrhythmias (ventricular flutter ≥230 bpm), and ventricular fibrillation.

Main Results:

  • No significant difference in the occurrence of ventricular arrhythmias (P = .49) between recent and late diagnosis groups.
  • No significant difference in the occurrence of malignant ventricular arrhythmias (P = .16) between the two cohorts.
  • Mean ejection fraction was 20.6% ± 8%, with a follow-up of 25.3 ± 24 months.

Conclusions:

  • Diagnosis duration of nonischemic DCM does not appear to reliably differentiate arrhythmic risk.
  • The 9-month time qualifier in CMS guidelines may not be optimal for identifying high-risk patients for ICD implantation.
  • Findings suggest current CMS criteria may not accurately stratify sudden cardiac death risk in this specific nonischemic DCM cohort.
Abstract

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