Effect of Significant Weight Change on Inappropriate Implantable Cardioverter-Defibrillator Therapy

Area of Science:

• Cardiology
• Medical Devices
• Heart Failure Management

Background:

• Heart failure (HF) patients receiving cardiac resynchronization therapy with defibrillator (CRT-D) may experience adverse outcomes with weight loss.
• The impact of significant weight changes on inappropriate implantable cardioverter-defibrillator (ICD) therapy in CRT-D patients remains unclear.

Purpose of the Study:

• To investigate the association between significant weight change at one year and subsequent inappropriate ICD therapy in CRT-D patients.
• To determine if weight change influences the risk of inappropriate ICD therapy, particularly that related to supraventricular arrhythmias (SVAs).

Main Methods:

• A cohort of 993 CRT-D patients from the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy was analyzed.
• Patients were categorized into weight loss (≥5%), weight gain (≥5%), and stable weight (<5% change) groups at one year post-enrollment.
• The primary outcome was inappropriate ICD therapy, with a secondary outcome focusing on SVAs-related inappropriate ICD therapy.

Main Results:

• 10.3% of patients experienced weight loss, 69.4% had stable weight, and 20.3% gained weight at one year.
• Weight loss was significantly associated with an increased risk of subsequent inappropriate ICD therapy compared to stable weight (HR=2.35) or weight gain (HR=2.27).
• Patients with weight loss also showed a higher risk of inappropriate ICD therapy related to SVAs compared to those with stable weight (HR=2.16).

Conclusions:

• Significant weight loss at one year post-implantation is linked to an elevated risk of inappropriate ICD therapy in patients with mild heart failure receiving CRT-D.
• The findings suggest that weight loss may increase the susceptibility to supraventricular arrhythmias, leading to higher rates of inappropriate ICD therapies.