Ventricular tachycardia/fibrillation early after defibrillator implantation in patients with hypertrophic cardiomyopathy is explained by a high-risk subgroup of patients

Alawi A. Alsheikh-Ali, Mark S. Link, Christopher Semsarian, Win Kuang Shen, N. A. Mark Estes, Martin S. Maron, Tammy S. Haas, Francesco Formisano, Giuseppe Boriani, Paolo Spirito, Barry J. Maron

Research output: Contribution to journalArticle

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Abstract

Background Implantable cardioverter-defibrillator (ICD) studies in patients with coronary artery disease report higher risk of ventricular tachycardia/fibrillation (VT/VF) early post-implant, potentially related to local proarrhythmic effects of ICD leads. Objective To characterize early and long-term risk of ICD discharge for VT/VF in a large hypertrophic cardiomyopathy (HCM) cohort. 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.

Original languageEnglish (US)
Pages (from-to)214-218
Number of pages5
JournalHeart Rhythm
Volume10
Issue number2
DOIs
StatePublished - Jan 1 2013

Fingerprint

Defibrillators
Hypertrophic Cardiomyopathy
Ventricular Fibrillation
Ventricular Tachycardia
Implantable Defibrillators
Confidence Intervals
Heart Arrest
Primary Prevention
Secondary Prevention
Registries
Coronary Artery Disease

Keywords

  • Hypertrophic cardiomyopathy
  • Implantable cardioverter-defibrillator
  • Ventricular fibrillation
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Ventricular tachycardia/fibrillation early after defibrillator implantation in patients with hypertrophic cardiomyopathy is explained by a high-risk subgroup of patients. / Alsheikh-Ali, Alawi A.; Link, Mark S.; Semsarian, Christopher; Shen, Win Kuang; Mark Estes, N. A.; Maron, Martin S.; Haas, Tammy S.; Formisano, Francesco; Boriani, Giuseppe; Spirito, Paolo; Maron, Barry J.

In: Heart Rhythm, Vol. 10, No. 2, 01.01.2013, p. 214-218.

Research output: Contribution to journalArticle

Alsheikh-Ali, AA, Link, MS, Semsarian, C, Shen, WK, Mark Estes, NA, Maron, MS, Haas, TS, Formisano, F, Boriani, G, Spirito, P & Maron, BJ 2013, 'Ventricular tachycardia/fibrillation early after defibrillator implantation in patients with hypertrophic cardiomyopathy is explained by a high-risk subgroup of patients', Heart Rhythm, vol. 10, no. 2, pp. 214-218. https://doi.org/10.1016/j.hrthm.2012.10.003
Alsheikh-Ali, Alawi A. ; Link, Mark S. ; Semsarian, Christopher ; Shen, Win Kuang ; Mark Estes, N. A. ; Maron, Martin S. ; Haas, Tammy S. ; Formisano, Francesco ; Boriani, Giuseppe ; Spirito, Paolo ; Maron, Barry J. / Ventricular tachycardia/fibrillation early after defibrillator implantation in patients with hypertrophic cardiomyopathy is explained by a high-risk subgroup of patients. In: Heart Rhythm. 2013 ; Vol. 10, No. 2. pp. 214-218.
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abstract = "Background Implantable cardioverter-defibrillator (ICD) studies in patients with coronary artery disease report higher risk of ventricular tachycardia/fibrillation (VT/VF) early post-implant, potentially related to local proarrhythmic effects of ICD leads. Objective To characterize early and long-term risk of ICD discharge for VT/VF in a large hypertrophic cardiomyopathy (HCM) cohort. 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.",
keywords = "Hypertrophic cardiomyopathy, Implantable cardioverter-defibrillator, Ventricular fibrillation, Ventricular tachycardia",
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T1 - Ventricular tachycardia/fibrillation early after defibrillator implantation in patients with hypertrophic cardiomyopathy is explained by a high-risk subgroup of patients

AU - Alsheikh-Ali, Alawi A.

AU - Link, Mark S.

AU - Semsarian, Christopher

AU - Shen, Win Kuang

AU - Mark Estes, N. A.

AU - Maron, Martin S.

AU - Haas, Tammy S.

AU - Formisano, Francesco

AU - Boriani, Giuseppe

AU - Spirito, Paolo

AU - Maron, Barry J.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - Background Implantable cardioverter-defibrillator (ICD) studies in patients with coronary artery disease report higher risk of ventricular tachycardia/fibrillation (VT/VF) early post-implant, potentially related to local proarrhythmic effects of ICD leads. Objective To characterize early and long-term risk of ICD discharge for VT/VF in a large hypertrophic cardiomyopathy (HCM) cohort. 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.

AB - Background Implantable cardioverter-defibrillator (ICD) studies in patients with coronary artery disease report higher risk of ventricular tachycardia/fibrillation (VT/VF) early post-implant, potentially related to local proarrhythmic effects of ICD leads. Objective To characterize early and long-term risk of ICD discharge for VT/VF in a large hypertrophic cardiomyopathy (HCM) cohort. 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.

KW - Hypertrophic cardiomyopathy

KW - Implantable cardioverter-defibrillator

KW - Ventricular fibrillation

KW - Ventricular tachycardia

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