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Published on: February 28, 2012
Syncope in Primary Prevention Implantable Cardioverter Defibrillator Implantation
Gustavo Goldenberg1, Tamir Bental1, Udi Kadmon1
1Department of Cardiology, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Patients with syncope prior to implantable cardioverter-defibrillator (ICD) implantation experienced more ventricular tachycardia/fibrillation and shocks. However, no significant differences in mortality were observed between syncopal and non-syncopal groups.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Syncope prognosis is highly variable, with 1-year mortality ranging from 0% for vasovagal events to 30% in heart disease patients.
- Implantable cardiac defibrillators (ICDs) are used for primary prevention of sudden cardiac death.
Purpose of the Study:
- To evaluate the outcomes and prognosis of patients receiving an ICD for primary prevention.
- To compare outcomes between patients with and without a history of syncope before ICD implantation.
Main Methods:
- Retrospective chart review of 75 patients with syncope history and 80 controls without syncope history, all undergoing ICD implantation for primary prevention.
- Assessment of ventricular tachycardia (VT), ventricular fibrillation (VF), shocks, anti-tachycardia pacing (ATP), and mortality during follow-up.
Main Results:
- Patients with prior syncope showed higher ejection fraction, more VT and VF episodes, and received more shocks and ATP.
- No significant differences were found in inappropriate shocks, cardiovascular mortality, or all-cause mortality between groups.
- Mean follow-up was comparable (893 days) in both syncopal and non-syncopal groups.
Conclusions:
- Syncope preceding ICD implantation is associated with increased VT/VF episodes and device therapies (shocks/ATP).
- Despite higher arrhythmic events, syncope does not appear to impact long-term mortality in primary prevention ICD patients.
Background:
Syncope prognosis varies widely: 1 year mortality may range from 0% in the case of vasovagal events up to 30% in the presence of heart disease.
Objectives:
To assess the outcomes and prognosis of patients with implantable cardiac defibrillator (ICD) and indication of primary prevention and compare patients presenting with or without prior syncope.
Methods:
We reviewed the charts of 75 patients who underwent ICD implantation with the indication of primary prevention and history of syncope and compared them to a control group of 80 patients without prior syncope. We assessed the number of ventricular tachycardia (VT), ventricular fibrillation (VF), shock, anti-tachycardia pacing (ATP), and death in each group during the follow-up.
Results:
Mean follow-up was 893 days (810-976, 95% confidence interval) (no difference between groups). Patients with prior syncope had a higher ejection fraction (EF) (35.5 ± 12.6 vs. 31.4 ± 8.76, P = 0.02), more episodes of VT (21.3% vs. 3.8%, P = 0.001) and VF (8% vs. 0%, P = 0.01) and also received more electric shocks (18.7% vs. 3.8%, P = 0.004) and ATP (17.3% vs. 6.2%, P = 0.031). There were no differences in inappropriate shocks (6.7% vs. 5%, P = 0.74), in cardiovascular mortality (cumulative 5 year estimate 29.9% vs. 32.2% P = 0.97) and any death (cumulative 5 year estimate 38.1% vs. 48.9% P = 0.18) during the follow-up.
Conclusions:
Syncopal patients before ICD implantation seem to have more episodes of VT/VF and shock or ATP. No mortality differences were observed.
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