Prognostic Importance of Defibrillator‐Appropriate Shocks and Antitachycardia Pacing in Patients With Mild Heart Failure
Background Patients with heart failure and an implantable cardioverter‐defibrillator (ICD) for primary prevention are at increased mortality risk after receiving shock therapy. We sought to determine the prognostic significance of ICD therapies, both shock and antitachycardia pacing, delivered for d...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2019-03-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.118.010346 |
| _version_ | 1811333971046301696 |
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| author | Yitschak Biton Usama A. Daimee Jayson R. Baman Valentina Kutyifa Scott McNitt Bronislava Polonsky Wojciech Zareba Ilan Goldenberg |
| author_facet | Yitschak Biton Usama A. Daimee Jayson R. Baman Valentina Kutyifa Scott McNitt Bronislava Polonsky Wojciech Zareba Ilan Goldenberg |
| author_sort | Yitschak Biton |
| collection | DOAJ |
| description | Background Patients with heart failure and an implantable cardioverter‐defibrillator (ICD) for primary prevention are at increased mortality risk after receiving shock therapy. We sought to determine the prognostic significance of ICD therapies, both shock and antitachycardia pacing, delivered for different ventricular arrhythmia (VA) rates. Methods and Results We evaluated mortality risk among 1790 ICD‐implanted patients from MADIT‐CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). For the first analysis, patients were divided into mutually exclusive groups by the rate of treated VA only: slow VA (<200 beats per minute) and fast VA (≥200 beats per minute or ventricular fibrillation). In a secondary analysis, both the type of ICD therapy and VA rate were used. The reference group was always patients who had no ICD therapy. ICD therapy for fast VA was associated with increased mortality risk (hazard ratio [HR], 2.27; 95% CI, 1.48–3.48; P<0.001). However, mortality risk after ICD therapy for slow VA was similar to the risk related to no ICD therapy (HR, 1.45; 95% CI, 0.86–2.44; P=0.162). Consistently, shocks (HR, 2.96; 95% CI, 1.91–4.60; P<0.001) and antitachycardia pacing (HR, 2.22; 95% CI, 0.96–5.14; P=0.063) for fast VA were both associated with increased mortality risk. Shocks and antitachycardia pacing for slow VA were not significantly associated with increased mortality risk (HR, 1.43 [95% CI, 0.52–3.92; P=0.489]; and HR, 1.43 [95% CI, 0.80–2.56; P=0.232], respectively). Conclusions In patients with mild heart failure receiving ICD for primary prevention, mortality is associated with the rate of underlying VA rather than the type of therapy. These findings suggest that fast VA is a marker for increased mortality rather than shock therapy directly contributing to increased risk. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271. |
| first_indexed | 2024-04-13T17:00:43Z |
| format | Article |
| id | doaj.art-d8ebde5a58184f1097a1b96ec689c7ed |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T17:00:43Z |
| publishDate | 2019-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-d8ebde5a58184f1097a1b96ec689c7ed2022-12-22T02:38:40ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-03-018610.1161/JAHA.118.010346Prognostic Importance of Defibrillator‐Appropriate Shocks and Antitachycardia Pacing in Patients With Mild Heart FailureYitschak Biton0Usama A. Daimee1Jayson R. Baman2Valentina Kutyifa3Scott McNitt4Bronislava Polonsky5Wojciech Zareba6Ilan Goldenberg7Heart Research Follow‐Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NYHeart Research Follow‐Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NYHeart Research Follow‐Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NYHeart Research Follow‐Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NYHeart Research Follow‐Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NYHeart Research Follow‐Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NYHeart Research Follow‐Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NYHeart Research Follow‐Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NYBackground Patients with heart failure and an implantable cardioverter‐defibrillator (ICD) for primary prevention are at increased mortality risk after receiving shock therapy. We sought to determine the prognostic significance of ICD therapies, both shock and antitachycardia pacing, delivered for different ventricular arrhythmia (VA) rates. Methods and Results We evaluated mortality risk among 1790 ICD‐implanted patients from MADIT‐CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). For the first analysis, patients were divided into mutually exclusive groups by the rate of treated VA only: slow VA (<200 beats per minute) and fast VA (≥200 beats per minute or ventricular fibrillation). In a secondary analysis, both the type of ICD therapy and VA rate were used. The reference group was always patients who had no ICD therapy. ICD therapy for fast VA was associated with increased mortality risk (hazard ratio [HR], 2.27; 95% CI, 1.48–3.48; P<0.001). However, mortality risk after ICD therapy for slow VA was similar to the risk related to no ICD therapy (HR, 1.45; 95% CI, 0.86–2.44; P=0.162). Consistently, shocks (HR, 2.96; 95% CI, 1.91–4.60; P<0.001) and antitachycardia pacing (HR, 2.22; 95% CI, 0.96–5.14; P=0.063) for fast VA were both associated with increased mortality risk. Shocks and antitachycardia pacing for slow VA were not significantly associated with increased mortality risk (HR, 1.43 [95% CI, 0.52–3.92; P=0.489]; and HR, 1.43 [95% CI, 0.80–2.56; P=0.232], respectively). Conclusions In patients with mild heart failure receiving ICD for primary prevention, mortality is associated with the rate of underlying VA rather than the type of therapy. These findings suggest that fast VA is a marker for increased mortality rather than shock therapy directly contributing to increased risk. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00180271.https://www.ahajournals.org/doi/10.1161/JAHA.118.010346cardiac resynchronization therapyheart failureimplantable cardioverter‐defibrillatormortalityshocks |
| spellingShingle | Yitschak Biton Usama A. Daimee Jayson R. Baman Valentina Kutyifa Scott McNitt Bronislava Polonsky Wojciech Zareba Ilan Goldenberg Prognostic Importance of Defibrillator‐Appropriate Shocks and Antitachycardia Pacing in Patients With Mild Heart Failure Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac resynchronization therapy heart failure implantable cardioverter‐defibrillator mortality shocks |
| title | Prognostic Importance of Defibrillator‐Appropriate Shocks and Antitachycardia Pacing in Patients With Mild Heart Failure |
| title_full | Prognostic Importance of Defibrillator‐Appropriate Shocks and Antitachycardia Pacing in Patients With Mild Heart Failure |
| title_fullStr | Prognostic Importance of Defibrillator‐Appropriate Shocks and Antitachycardia Pacing in Patients With Mild Heart Failure |
| title_full_unstemmed | Prognostic Importance of Defibrillator‐Appropriate Shocks and Antitachycardia Pacing in Patients With Mild Heart Failure |
| title_short | Prognostic Importance of Defibrillator‐Appropriate Shocks and Antitachycardia Pacing in Patients With Mild Heart Failure |
| title_sort | prognostic importance of defibrillator appropriate shocks and antitachycardia pacing in patients with mild heart failure |
| topic | cardiac resynchronization therapy heart failure implantable cardioverter‐defibrillator mortality shocks |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.118.010346 |
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