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Published on: February 28, 2012
Incidence of ventricular arrhythmic events in CKD patients with ICD
Márcio Galindo Kiuchi1, Shaojie Chen2, Helmut Pürerfellner3
1Divisão de Cirurgia Cardíaca, Departamento de Medicina, Hospital e Clínica São Gonçalo, São Gonçalo, RJ, Brazil; Department of Cardiology, Elisabethinen University Teaching Hospital Linz, Linz, Austria.
Insights
Patients with advanced chronic kidney disease (CKD) experience significantly more anti-tachycardia pacing (ATP) and shock events from their implantable cardioverter-defibrillators (ICDs). This highlights a critical link between CKD progression and cardiac device therapy needs.
Area of Science:
- Cardiology
- Nephrology
- Biomedical Engineering
Background:
- Chronic kidney disease (CKD) affects cardiovascular health, particularly in patients with left ventricular dysfunction.
- Automatic implantable cardioverter-defibrillators (ICDs) are used to manage life-threatening arrhythmias.
- The impact of CKD stages on ICD therapies is not fully understood.
Purpose of the Study:
- To investigate the incidence and severity of anti-tachycardia therapy pacing (ATP) and shock events in patients with CKD stages 1-4.
- To compare these arrhythmic events between different stages of CKD in patients with left ventricular dysfunction and ICDs.
Main Methods:
- Seventy-six patients with CKD stages 1-4, left ventricular dysfunction, and ICDs were enrolled.
- Patients underwent follow-up evaluations every three months for one year.
- Arrhythmic events, including ATP and shock, were assessed at each visit.
Main Results:
- Patients with CKD stage 4 experienced significantly higher numbers of ATP (45.1±4.4) and shock (33.3±5.0) events compared to other CKD stages (P<0.0001).
- Over 12 months, 69% of patients received ATP and 63% received shocks, with significantly higher rates in CKD stage 4.
- Hazard ratios for ATP and shock events were substantially elevated in CKD stage 4 patients compared to stages 1, 2, and 3 (P<0.05 for all comparisons).
Conclusions:
- The severity of chronic kidney disease is directly correlated with an increased risk of anti-tachycardia pacing and shock events in patients with ICDs.
- These findings underscore the importance of considering CKD stage in managing patients with cardiac devices.
- Further research may elucidate mechanisms linking CKD progression to increased arrhythmic events and ICD therapies.
Aim:
This study examined patients with chronic kidney disease (CKD) in stages 1, 2, 3 and 4, left ventricular dysfunction and automatic implantable cardioverter-defibrillator (ICD). Our goal was to record the appropriate therapies, "Anti-tachycardia Therapy Pacing" (ATP) and shock events during the 12months of follow-up and compare the incidence and severity of these at different stages of CKD.
Methods:
Seventy-six patients were evaluated once every three months till one year of follow-up. The arrhythmic events were assessed at each follow-up visit.
Results:
Comparing the groups, patients with CKD stage 4 had a higher number of ATP (45.1±4.4) and shock (33.3±5.0) events compared to other groups (P<0.0001 for both comparisons in relation to other groups). Along the 12months, 69% received ATP and 63% were treated with shock, P<0.0001 by Log-rank/Mantel-Haenszel test compared to the other groups. Regarding the ATP events, patients with CKD stage 4 showed the hazard ratio (HR) of 11.800, with a confidence interval of 95% (CI 95%) from 3.673 to 37,930, P<0.0001 vs. patients with CKD stage 1; HR of 7.957, with a CI 95% from 2.578 to 24.570, P<0.0001 vs. patients with CKD stage 2; and HR of 2.902, with a CI 95% 1.054-7.986, P=0.0391 vs. patients with CKD stage 3. In relation to the shock events, patients with CKD stage 4 showed the HR of 20,010, with a CI 95% from 5.262 to 76.080, P<0.0001 vs. patients with CKD stage 1; HR of 10.060 with a CI 95% 3.026-33.450, P=0.0001 vs. patients with CKD stage 2; and HR of 2.880, with a CI 95% 1.029-8.060, P=0.0323 vs. patients with CKD stage 3.
Conclusion:
Our results suggest that the more advanced the stage of CKD higher the HR of ATP and shock events.
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