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Long-term prognosis and prognostic factors after primary prophylactic implantable cardioverter-defibrillator therapy

Masafumi Sugawara1, Yusuke Kondo1, Satoko Ryuzaki1

  • 1Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.

Journal of Cardiology
|February 21, 2024
PubMed

Insights

Non-sustained ventricular tachycardia (NSVT) does not predict major adverse cardiac events (MACE) in heart failure with reduced ejection fraction (HFrEF) patients receiving prophylactic implantable cardioverter-defibrillators (ICDs). Atrial fibrillation, however, is linked to a worse prognosis in these patients.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Limited understanding of prophylactic therapy selection for ischemic cardiomyopathy (ICM) patients in the primary percutaneous intervention era.
  • Need to evaluate the role of non-sustained ventricular tachycardia (NSVT) in predicting adverse outcomes for heart failure with reduced ejection fraction (HFrEF) patients.

Purpose of the Study:

  • To investigate the influence of NSVT on major adverse cardiac events (MACE) in HFrEF patients with ICM.
  • To identify predictors of MACE in patients undergoing primary prophylactic implantable cardioverter-defibrillator (ICD) implantation.

Main Methods:

  • Retrospective analysis of ICM and non-ICM patients who received ICD implantation between October 2006 and August 2020.
  • MACE defined as a composite of cardiovascular death, heart failure hospitalization, and appropriate ICD therapies.
  • Multivariable Cox analysis to identify independent predictors of MACE.

Main Results:

  • 167 patients enrolled; 74% had NSVT, 34% had ICM.
  • MACE occurred in 43% of patients during a median follow-up of 61 months.
  • Atrial fibrillation (HR 2.00; p=0.01) was an independent predictor of MACE, while NSVT was not.

Conclusions:

  • Prior NSVT is not an independent predictor of future MACE in HFrEF patients with primary prophylactic ICD.
  • Atrial fibrillation is associated with a worse prognosis in this patient group.
  • Comprehensive risk stratification including atrial fibrillation is crucial for predicting MACE in patients with primary prophylactic ICD.
Abstract

Keywords:
Ischemic cardiomyopathyNon-ischemic cardiomyopathyNon-sustained ventricular tachycardiaPrimary prophylactic implantable cardioverter-defibrillatorReduced left ventricular ejection fraction

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