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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Implantable cardiac defibrillator events in patients with arrhythmogenic right ventricular cardiomyopathy
Olgierd Woźniak1, Karolina Borowiec2, Marek Konka2
1Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland owozniak@wp.pl.
Insights
Arrhythmogenic right ventricular cardiomyopathy (ARVC) patients with right ventricle dysfunction, younger age, or a history of ventricular tachycardia face higher risks of appropriate ICD interventions. These findings aid in refining risk stratification for ARVC patients needing defibrillators.
Area of Science:
- Cardiology
- Electrophysiology
- Genetics
Background:
- Arrhythmogenic right ventricular cardiomyopathy (ARVC) poses a significant risk of sudden cardiac death.
- Current strategies for optimal risk stratification in ARVC patients are still under investigation.
- Implantable cardioverter-defibrillators (ICDs) are crucial for managing life-threatening arrhythmias in ARVC.
Purpose of the Study:
- To identify predictors of appropriate and inappropriate ICD interventions in ARVC patients.
- To enhance risk stratification models for ARVC patients undergoing ICD implantation.
- To analyze long-term outcomes of ICD therapy in a cohort of ARVC patients.
Main Methods:
- A 20-year, single-centre observational study involving 65 adult ARVC patients who received ICDs.
- Analysis of primary or secondary prevention ICD implantation for sudden cardiac death.
- Evaluation of appropriate (shock/pacing) and inappropriate ICD interventions as study endpoints.
Main Results:
- During a median 7.75-year follow-up, 66.2% of patients experienced appropriate ICD interventions.
- Predictors for appropriate ICD interventions included right ventricle dysfunction (HR 2.85), age <40 years (HR 2.37), and history of sustained ventricular tachycardia (HR 2.55).
- No significant predictors for inappropriate ICD therapy were identified; 27.7% of patients had inappropriate interventions.
Conclusions:
- Right ventricle dysfunction, younger age at implantation (<40 years), and a history of sustained ventricular tachycardia are key predictors of appropriate ICD interventions in ARVC.
- These identified predictors can inform improved risk stratification protocols prior to ICD implantation in ARVC patients.
- Further research may refine patient selection for ICDs to optimize outcomes in ARVC.
Objective:
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with a risk of sudden cardiac death. Optimal risk stratification is still under debate. The main purpose of this long-term, single-centre observation was to analyse predictors of appropriate and inappropriate implantable cardioverter-defibrillator (ICD) interventions in the population of patients with ARVC with a high risk of life-threatening arrhythmias.
Methods:
The study comprised 65 adult patients (median age 40 years, 48 men) with a definite diagnosis of ARVC who received ICD over a time span of 20 years in primary (40%) or secondary (60%) prevention of sudden cardiac death. The study endpoints were first appropriate and inappropriate ICD interventions (shock or antitachycardia pacing) after device implantation.
Results:
During a median follow-up of 7.75 years after ICD implantation, nine patients died and six individuals underwent heart transplantation. Appropriate ICD interventions occurred in 43 patients (66.2%) and inappropriate ICD interventions in 18 patients (27.7%). Multivariable analysis using cause-specific hazard model identified three predictors of appropriate ICD interventions: right ventricle dysfunction (cause-specific HR 2.85, 95% CI 1.56 to 5.21, p<0.001), age <40 years at ICD implantation (cause-specific HR 2.37, 95% CI 1.13 to 4.94, p=0.022) and a history of sustained ventricular tachycardia (cause-specific HR 2.55, 95% CI 1.16 to 5.63, p=0.020). Predictors of inappropriate ICD therapy were not found. Complications related to ICD implantation occurred in 12 patients.
Conclusions:
Right ventricle dysfunction, age <40 years and a history of sustained ventricular tachycardia were predictors of appropriate ICD interventions in patients with ARVC. The results may be used to improve risk stratification before ICD implantation.
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