Heart rhythm · 2024
Risk of recurrent ventricular tachyarrhythmia following the occurrence of a first ventricular arrhythmic event in patients with a primary prevention implantable cardioverter-defibrillator.
СтатьяМногоцентровое исследованиеРандомизированное исследованиеПоддержка NIH: внешняя программаПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Wang Matthew, Goldenberg Ilan, Younis Arwa, Goldenberg Ido, Christof Michael, Huang David T, McNitt Scott, Polonsky Bronislava, Kutyifa Valentina, Zareba Wojciech, Ojo Amole, Aktaş Mehmet K
Аннотация
BACKGROUND: There are limited data on clinical and arrhythmic outcomes after a first ventricular tachyarrhythmia (VTA) in heart failure (HF) patients who receive a primary prevention implantable cardioverter-defibrillator (ICD).
OBJECTIVE: This study was designed to quantify the burden of and to identify risk factors for recurrent VTA in this population and to evaluate the risk of all-cause mortality associated with recurrent VTA.
METHODS: The study comprised 789 patients who experienced VTA following primary prevention ICD implantation in 5 ICD trials (MADIT-II, MADIT-RISK, MADIT-CRT, MADIT-RIT, RAID). Landmark analysis was used to quantify the burden and to identify predictors of recurrent VTA. Time-dependent analysis was used to evaluate the association of VTA recurrence with subsequent mortality.
RESULTS: The mean age of the study patients was 63 years, and 17% were women. The cumulative probability of experiencing at least 1 recurrent VTA episode at 3 years after a first VTA episode was 60%; the recurrent VTA burden after a first event during 3 years was 2.8 episodes per patient. The risk of recurrent VTA remained ≥56% at 3 years regardless of baseline clinical and echocardiographic risk factors. VTA recurrence was associated with a significant 2-fold increased risk of subsequent all-cause mortality.
CONCLUSION: Patients with a primary prevention ICD who experience an episode of VTA are at high risk of recurrent VTA, regardless of baseline risk factors. Recurrent VTA is associated with a pronounced increase in the risk of death. These findings suggest a need for early intervention after a first VTA in patients who receive a primary prevention ICD.
OBJECTIVE: This study was designed to quantify the burden of and to identify risk factors for recurrent VTA in this population and to evaluate the risk of all-cause mortality associated with recurrent VTA.
METHODS: The study comprised 789 patients who experienced VTA following primary prevention ICD implantation in 5 ICD trials (MADIT-II, MADIT-RISK, MADIT-CRT, MADIT-RIT, RAID). Landmark analysis was used to quantify the burden and to identify predictors of recurrent VTA. Time-dependent analysis was used to evaluate the association of VTA recurrence with subsequent mortality.
RESULTS: The mean age of the study patients was 63 years, and 17% were women. The cumulative probability of experiencing at least 1 recurrent VTA episode at 3 years after a first VTA episode was 60%; the recurrent VTA burden after a first event during 3 years was 2.8 episodes per patient. The risk of recurrent VTA remained ≥56% at 3 years regardless of baseline clinical and echocardiographic risk factors. VTA recurrence was associated with a significant 2-fold increased risk of subsequent all-cause mortality.
CONCLUSION: Patients with a primary prevention ICD who experience an episode of VTA are at high risk of recurrent VTA, regardless of baseline risk factors. Recurrent VTA is associated with a pronounced increase in the risk of death. These findings suggest a need for early intervention after a first VTA in patients who receive a primary prevention ICD.