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Comparable Efficacy in Ischemic and Non-Ischemic ICD Recipients for the Primary Prevention of Sudden Cardiac Death
Andreea Maria Ursaru1, Antoniu Octavian Petris1,2, Irina Iuliana Costache1,2
1Department of Cardiology, Emergency Clinical Hospital "Sf. Spiridon", 700111 Iași, Romania.
Insights
Implantable cardioverter defibrillators (ICDs) reduce sudden cardiac death in heart failure patients. This study found similar cardiovascular mortality and appropriate ICD therapy rates in both ischemic and non-ischemic cardiomyopathy patients receiving ICDs for primary prevention.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Heart failure patients face high mortality from hemodynamic failure and ventricular arrhythmias.
- Implantable cardioverter defibrillators (ICDs) are crucial for reducing arrhythmic sudden death.
- Patient response to ICD therapy varies, necessitating further investigation into specific etiologies.
Purpose of the Study:
- To compare cardiovascular mortality and outcomes in patients with ischemic cardiomyopathy (ICMP) versus non-ischemic cardiomyopathy (NICMP) receiving ICDs for primary prevention.
- To evaluate the effectiveness of ICD therapy in reducing all-cause mortality and sudden cardiac death across different heart failure etiologies.
- To assess the rates of appropriate ICD therapies and ventricular tachyarrhythmia recurrence in ICMP and NICMP patients.
Main Methods:
- Retrospective analysis of 403 consecutive symptomatic heart failure patients who received ICDs for primary prevention.
- Categorization of patients into ischemic cardiomyopathy (59%) and non-ischemic cardiomyopathy (41%) groups.
- Follow-up for a median of 36 months to record cardiovascular death, all-cause mortality, sudden cardiac death, and ICD therapies.
Main Results:
- No significant difference in cardiovascular mortality between NICMP (5.4%) and ICMP (5.9%) groups (HR 1; p=0.97).
- Comparable rates of all-cause mortality (NICMP 8.4% vs. ICMP 7.6%) and sudden cardiac death (NICMP 1.2% vs. ICMP 1.7%) were observed.
- The rate of appropriate ICD therapies for ventricular tachyarrhythmias was similar in both ICMP and NICMP patient groups.
Conclusions:
- ICD implantation for primary prevention in systolic heart failure yields similar cardiovascular and all-cause mortality rates regardless of ischemic or non-ischemic etiology.
- Patients with non-ischemic cardiomyopathy and ischemic cardiomyopathy demonstrate comparable outcomes regarding recurrent ventricular tachyarrhythmias and need for appropriate ICD therapies.
- ICD therapy is an effective strategy for managing sudden cardiac death risk in diverse heart failure populations.
Abstract:
(1) Background: In patients suffering from heart failure, the main causes of death are either hemodynamic failure, or ventricular arrhythmias. The only tool to significantly reduce arrhythmic sudden death is the implantable cardioverter defibrillator (ICD), but not all patients benefit to the same extent from these devices. (2) Methods: The primary outcome of this single-center study was defined as cardiovascular death in patients with ischemic and non-ischemic heart failure who have benefited from ICD therapy. The secondary outcomes were death from any cause, sudden cardiac death, ICD-related therapies (appropriate antitachycardia pacing or shock therapy for ventricular tachycardia or fibrillation) and recurrences of ventricular tachyarrhythmias. (3) Results: A total of 403 consecutive ICD recipients-symptomatic heart failure patients with ICD for the primary prevention of sudden cardiac death-were included retrospectively: 59% ischemic cardiomyopathy (ICMP) and 41% non-ischemic cardiomyopathy (NICMP) patients. Within a median follow-up period of 36 months, the incidence of cardiovascular mortality was not significantly different in patients with NICMP and ICMP: the primary outcome had occurred in 9 patients (5.4%) in the NICMP group and in 14 patients (5.9%) in the ICMP group (hazard ratio 1; 95% confidence interval (CI) 0.45 to 2.28; p = 0.97). All-cause mortality occurred in 14 of 166 patients (8.4%) in the NICMP group and 18 of 237 patients (7.6%) in the ICMP group. Sudden cardiac death occurred in two patients (1.2%) in the NICMP group and in four patients (1.7%) in the ICMP group (hazard ratio 0.71; 95% CI, 0.13 to 3.88; p = 0.69). The rate of appropriate device therapies was comparable in both groups. (4) Conclusions: In this study, ICD implantation for primary prevention of sudden cardiac death in patients with symptomatic systolic heart failure was associated with similar rates of cardiovascular and all-cause mortality in patients with ischemic heart disease, and in patients with heart failure from other causes. NICMP and ICMP showed comparable rates of recurrent ventricular tachyarrhythmias and appropriate ICD therapies.
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