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Published on: February 28, 2012
Implantable cardioverter defibrillators in patients with valvular cardiomyopathy
Alfred G Valles1, Farhan J Khawaja, Bernard J Gersh
1Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Insights
Implantable cardioverter-defibrillators (ICDs) are effective for preventing sudden cardiac death (SCD) in valvular cardiomyopathy (VCM) patients. Outcomes, including mortality and shock rates, were similar to those with other cardiomyopathies.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Surgery
Background:
- Implantable cardioverter-defibrillators (ICDs) are crucial for preventing sudden cardiac death (SCD) in high-risk patients.
- Valvular cardiomyopathy (VCM) is a significant condition requiring careful management strategies.
Purpose of the Study:
- To evaluate the effectiveness and outcomes of ICD implantation in patients with VCM post-valve surgery.
- To compare these outcomes against control groups with ischemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM).
Main Methods:
- Retrospective analysis of VCM patients who received ICDs after valve surgery.
- Comparison with age- and sex-matched cohorts with ICM and DCM receiving ICDs.
- Inclusion of a VCM group without ICDs as an additional control.
Main Results:
- No significant difference in survival was observed among ICD groups (VCM, ICM, DCM) after a median follow-up of 4.1 years.
- Appropriate ICD discharge rates were comparable across VCM, ICM, and DCM groups (5%, 10%, and 4% annually, respectively).
- VCM patients with ICDs showed similar survival to those without ICDs, despite reduced left ventricular ejection fraction (LVEF).
Conclusions:
- ICD implantation in VCM patients undergoing valve surgery yields outcomes comparable to those with ICM and DCM.
- These findings suggest ICDs are a viable option for SCD prevention in VCM.
- Larger prospective studies are recommended to confirm these hypothesis-generating results.
Background:
Implantable cardioverter-defibrillators (ICDs) are beneficial for preventing sudden cardiac death (SCD) in patients with previous SCD or left ventricular dysfunction.
Objective:
The objective was to investigate the outcomes of ICD implantation in patients who have surgery for valvular cardiomyopathy (VCM).
Methods:
We identified patients with VCM who had ICD implantation after valve surgery. Age- and sex-matched patients who received an ICD for ischemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM) served as controls. Patients with VCM who had valve surgery but did not receive an ICD served as an additional control group. We compared mortality and appropriate ICD discharges between the study group and control groups.
Results:
Mean (SD) age (31 patients with VCM with ICD, 30 with ICM, 26 with DCM, and 62 patients with VCM without ICD) was 60 (15) years, 73% were men. Ejection fraction at ICD implantation was 34%, 26%, and 23% for the VCM with ICD, ICM, and DCM groups, respectively (P = 0.03). After a median follow-up of 4.1 years, survival was not significantly different among ICD groups (P = 0.06). The annual appropriate shock rate was 5%, 10%, and 4% for the VCM with ICD, ICM, and DCM groups, respectively (P = 0.71). Compared to VCM without ICD, patients with VCM and ICD had comparable survival (P = 0.82) despite a reduced LVEF following valve surgery.
Conclusion:
Patients with VCM who undergo ICD implantation for SCD prevention have similar appropriate ICD discharge rates and mortality as do those with ICM and DCM. These data are hypothesis generating and deserve confirmation with large-scale prospective studies.
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