Abstract | BACKGROUND: OBJECTIVE: METHODS: By using HCM multicenter registry data, we compared long-term risk of VT/VF subsequent to an early post-implant period (a priori defined as within 3 months of implant) between patients with or without VT/VF within 3 months after ICD implantation. RESULTS: Over a median follow-up of 4.3 years, 109 of 506 (22%) patients with HCM who received ICDs received at least 1 ICD discharge for VT/VF. Risk of first ICD discharge for VT/VF was highest in the first year post-implant (10.8% per person-year; 95% confidence interval 7.9-13.8) and particularly in the first 3 months (17.0% per person-year; 95% confidence interval 9.8-24.3). Patients with early VT/VF (≤3 months post-implant) were older, and more commonly had secondary prevention ICDs following cardiac arrest or systolic dysfunction (end-stage HCM with ejection fraction<50%). Only 2 of 247 (0.7%) patients with primary prevention ICDs and preserved systolic function had early VT/VF. Patients with VT/VF early post-implant (≤3 months) had more than 5-fold higher risk for future VT/VF during long-term follow-up compared with patients without early VT/VF (adjusted hazard ratio 5.4; 95% confidence interval 2.3-12.6). CONCLUSIONS: High-risk patients with HCM and VT/VF early after ICD implantation are particularly prone to subsequent VT/VF throughout follow-up. Early ICD interventions for VT/VF are largely confined to patients with prior cardiac arrest or systolic dysfunction and therefore more likely driven by higher arrhythmic risk rather than lead-related proarrhythmia.
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Authors | Alawi A Alsheikh-Ali, Mark S Link, Christopher Semsarian, Win-Kuang Shen, N A Mark Estes 3rd, Martin S Maron, Tammy S Haas, Francesco Formisano, Giuseppe Boriani, Paolo Spirito, Barry J Maron |
Journal | Heart rhythm
(Heart Rhythm)
Vol. 10
Issue 2
Pg. 214-8
(Feb 2013)
ISSN: 1556-3871 [Electronic] United States |
PMID | 23041573
(Publication Type: Comparative Study, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2013 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved. |
Topics |
- Adult
- Age Factors
- Aged
- Australia
- Cardiomyopathy, Hypertrophic
(diagnosis, mortality, therapy)
- Confidence Intervals
- Databases, Factual
- Death, Sudden, Cardiac
(etiology)
- Defibrillators, Implantable
(adverse effects)
- Electric Countershock
(adverse effects)
- Europe
- Female
- Humans
- Kaplan-Meier Estimate
- Male
- Middle Aged
- Prognosis
- Proportional Hazards Models
- Registries
- Retrospective Studies
- Risk Assessment
- Sex Factors
- Statistics, Nonparametric
- Survival Analysis
- Tachycardia, Ventricular
(diagnosis, mortality, therapy)
- Treatment Outcome
- United States
- Ventricular Fibrillation
(diagnosis, mortality, therapy)
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