Document Type : Original Article(s)

Authors

1 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

2 Assistant Professor, Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

BACKGROUND: Although intra-cardiac shocks are a lifesaving approach in patients with systolic heart failure (HF), the probable effective factors related to shock occurrence are less frequently recognized. We designed this study to assess the factors associated with inappropriate or appropriate implantable cardioverter-defibrillator (ICD) shocks in patients with non-ischemic cardiomyopathy (NICM).
METHODS: Ninety-nine patients with NICM who implanted ICD were enrolled from March 2018 to September 2019 and followed up with a three-month interval for up to one year. Shock therapy was defined as either appropriate or inappropriate shock. The odds ratio (OR) of inappropriate shock occurrence was calculated with crude and different adjusted models.
RESULTS: The mean age of the population at baseline was 51.9 ± 15.4 years (men: 71%). Baseline data revealed that patients with inappropriate shocks had higher heart rates (HR), worse New York Heart Association (NYHA) class, and anti-tachycardia pacing (ATP) as well as higher percentages of amiodarone usage compared to groups with appropriate or no shock [HR: 96.8 ± 27.8 vs. 79.8 ± 12.1 vs. 76.2 ± 17.6 beats per minute (bpm), P = 0.014; NYHA class IV: 85.7% vs. 74.1% vs. 63.4%, P = 0.041; ATP: 37.5% vs. 29% vs. 5%, P = 0.010; amiodarone usage: 37.5% vs. 25.8% vs. 5%, P = 0.23, respectively]. Further multiple-adjusted OR did not reveal any significant independent association between the aforementioned variables and inappropriate shock incidence.
CONCLUSION: This study indicates no significant independent predisposing factor in the occurrence of inappropriate shocks among patients with NICM. Other studies are required in this regard.

Keywords

  1. Ouellet G, Huang DT, Moss AJ, Hall WJ, Barsheshet A, McNitt S, et al. Effect of cardiac resynchronization therapy on the risk of first and recurrent ventricular tachyarrhythmic events in MADIT-CRT. J Am Coll Cardiol 2012; 60(18): 1809-16.
  2. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37(27): 2129-200.
  3. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr., Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128(16): e240-e327.
  4. Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicenter Automatic Defibrillator Implantation Trial Investigators. N Engl J Med 1996; 335(26): 1933-40.
  5. Dichtl W, Wolber T, Paoli U, Brullmann S, Stuhlinger M, Berger T, et al. Appropriate therapy but not inappropriate shocks predict survival in implantable cardioverter defibrillator patients. Clin Cardiol 2011; 34(7): 433-6.
  6. van Rees JB, Borleffs CJ, de Bie MK, Stijnen T, van Eeven L, Bax JJ, et al. Inappropriate implantable cardioverter-defibrillator shocks: Incidence, predictors, and impact on mortality. J Am Coll Cardiol 2011; 57(5): 556-62.
  7. Kleemann T, Hochadel M, Strauss M, Skarlos A, Seidl K, Zahn R. Comparison between atrial fibrillation-triggered implantable cardioverter-defibrillator (ICD) shocks and inappropriate shocks caused by lead failure: different impact on prognosis in clinical practice. J Cardiovasc Electrophysiol 2012; 23(7): 735-40.
  8. Sood N, Ruwald AC, Solomon S, Daubert JP, McNitt S, Polonsky B, et al. Association between myocardial substrate, implantable cardioverter defibrillator shocks and mortality in MADIT-CRT. Eur Heart J 2014; 35(2): 106-15.
  9. Steinbeck G, Dorwarth U, Mattke S, Hoffmann E, Markewitz A, Kaulbach H, et al. Hemodynamic deterioration during ICD implant: Predictors of high-risk patients. Am Heart J 1994; 127(4 Pt 2): 1064-7.
  10. Saxon LA, Hayes DL, Gilliam FR, Heidenreich PA, Day J, Seth M, et al. Long-term outcome after ICD and CRT implantation and influence of remote device follow-up: The ALTITUDE survival study. Circulation 2010; 122(23): 2359-67.
  11. Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R, et al. Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med 2005; 352(3): 225-37.
  12. Sweeney MO, Sherfesee L, DeGroot PJ, Wathen MS, Wilkoff BL. Differences in effects of electrical therapy type for ventricular arrhythmias on mortality in implantable cardioverter-defibrillator patients. Heart Rhythm 2010; 7(3): 353-60.
  13. Woo A, Monakier D, Harris L, Hill A, Shah P, Wigle ED, et al. Determinants of implantable defibrillator discharges in high-risk patients with hypertrophic cardiomyopathy. Heart 2007; 93(9): 1044-5.
  14. Rajamani K, Goldberg AS, Wilkoff BL. Shock avoidance and the newer tachycardia therapy algorithms. Cardiol Clin 2014; 32(2): 191-200.
  15. Jagielski D, Zysko D, Nadolny K, Wizowska J, Biel B, Banasiak W, et al. Predictors of inappropriate shocks from implantable cardioverter-defibrillators. Wiad Lek 2019; 72(7): 1243-6.
  16. Tenma T, Yokoshiki H, Mizukami K, Mitsuyama H, Watanabe M, Sasaki R, et al. Predictors and proarrhythmic consequences of inappropriate implantable cardioverter-defibrillator therapy. Circ J 2015; 79(9): 1920-7.
  17. Yang JH, Byeon K, Yim HR, Park JW, Park SJ, Huh J, et al. Predictors and clinical impact of inappropriate implantable cardioverter-defibrillator shocks in Korean patients. J Korean Med Sci 2012; 27(6): 619-24.
  18. Mustafa U, Dherange P, Reddy R, DeVillier J, Chong J, Ihsan A, et al. Atrial fibrillation is associated with higher overall mortality in patients with implantable cardioverter-defibrillator: A systematic review and meta-analysis. J Am Heart Assoc 2018; 7(22): e010156.
  19. Khan SU, Ghimire S, Talluri S, Rahman H, Khan MU, Nasir F, et al. Implantable cardioverter defibrillator in nonischemic cardiomyopathy: A systematic review and meta-analysis. J Arrhythm 2018; 34(1): 4-10.
  20. Marinheiro R, Parreira L, Amador P, Sa C, Duarte T, Fonseca M, et al. Are defibrillators less useful in patients with non-ischemic heart disease? Rev Port Cardiol (Engl Ed) 2018; 37(10): 835-41.
  21. Kober L, Thune JJ, Nielsen JC, Haarbo J, Videbaek L, Korup E, et al. Defibrillator implantation in patients with nonischemic systolic heart failure. N Engl J Med 2016; 375(13): 1221-30.
  22. Moss AJ, Schuger C, Beck CA, Brown MW, Cannom DS, Daubert JP, et al. Reduction in inappropriate therapy and mortality through ICD programming. N Engl J Med 2012; 367(24): 2275-83.
  23. Kreuz J, Horlbeck F, Hoyer F, Mellert F, Fimmers R, Lickfett L, et al. An impaired renal function: A predictor of ventricular arrhythmias and mortality in patients with nonischemic cardiomyopathy and heart failure. Pacing Clin Electrophysiol 2011; 34(7): 894-9.
  24. Saxon LA, Bristow MR, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Predictors of sudden cardiac death and appropriate shock in the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Trial. Circulation 2006; 114(25): 2766-72.
  25. Kreuz J, Balta O, Linhart M, Fimmers R, Lickfett L, Mellert F, et al. An impaired renal function and advanced heart failure represent independent predictors of the incidence of malignant ventricular arrhythmias in patients with an implantable cardioverter/defibrillator for primary prevention. Europace 2010; 12(10): 1439-45.
  26. Santangeli P, Rame JE, Birati EY, Marchlinski FE. Management of ventricular arrhythmias in patients with advanced heart failure. J Am Coll Cardiol 2017; 69(14): 1842-60.
  27. Ramakumar V, Naik N. Current status of the ICD in nonischemic cardiomyopathy. Journal of the Practice of Cardiovascular Sciences 2018; 4(1): 6-9.
  28. Hori M, Okamoto H. Heart rate as a target of treatment of chronic heart failure. J Cardiol 2012; 60(2): 86-90.
  29. Palatini P, Julius S. Elevated heart rate: a major risk factor for cardiovascular disease. Clin Exp Hypertens 2004; 26(7-8): 637-44.
  30. Jouven X, Empana JP, Schwartz PJ, Desnos M, Courbon D, Ducimetiere P. Heart-rate profile during exercise as a predictor of sudden death. N Engl J Med 2005; 352(19): 1951-8.
  31. Fuster V, Ryden LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA, et al. 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. J Am
    Coll Cardiol 2011; 57(11): e101-e198.
  32. Kadish A, Dyer A, Daubert JP, Quigg R, Estes NA, Anderson KP, et al. Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med 2004; 350(21): 2151-8.
  33. Back SH, Kowey PR. Strategies to reduce recurrent shocks due to ventricular arrhythmias in patients with an implanted cardioverter-defibrillator. Arrhythm Electrophysiol Rev 2019; 8(2): 99-104.
  34. Swerdlow CD, Wang PJ, Zipes DP. Pacemakers and Implantable Cardioverter-Defibrillators. In: Libby P, Zipes DP, Bonow RO, Mann DL, Tomaselli GF, editors. Braunwald Heart Disease. 11th Philadelphia, PA: Saunders/ Elsevier; 2019. p. 790.
  35. Wathen MS, DeGroot PJ, Sweeney MO, Stark AJ, Otterness MF, Adkisson WO, et al. Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter-defibrillators: Pacing Fast Ventricular Tachycardia Reduces Shock Therapies (PainFREE Rx II) trial results. Circulation 2004; 110(17): 2591-6.
  36. Wilkoff BL, Williamson BD, Stern RS, Moore SL, Lu F, Lee SW, et al. Strategic programming of detection and therapy parameters in implantable cardioverter-defibrillators reduces shocks in primary prevention patients: Results from the PREPARE (Primary Prevention Parameters Evaluation) study. J Am Coll Cardiol 2008; 52(7): 541-50.
  37. Connolly SJ, Dorian P, Roberts RS, Gent M, Bailin S, Fain ES, et al. Comparison of beta-blockers, amiodarone plus beta-blockers, or sotalol for prevention of shocks from implantable cardioverter defibrillators: the OPTIC Study: a randomized trial. JAMA 2006; 295(2): 165-71.
  38. Lee CH, Nam GB, Park HG, Kim HY, Park KM, Kim J, et al. Effects of antiarrhythmic drugs on inappropriate shocks in patients with implantable cardioverter defibrillators. Circ J 2008; 72(1): 102-5.
  39. Maeder M, Rickli H, Sticherling C, Widmer R, Ammann P. Hypokalaemia and sudden cardiac death--lessons from implantable cardioverter defibrillators. Emerg Med J 2007; 24(3): 206-8.
  40. Skogestad J, Aronsen JM. Hypokalemia-induced arrhythmias and heart failure: New insights and implications for therapy. Front Physiol 2018; 9: 1500.