Clinical Electrophysiology -> SCA Risk Assessment: -> Other Noninvasive Techniques
D-AB10 - Ventricular Arrhythmias from Mechanism to New Ablation Targets (ID 52)
Abstract Plus
D-AB10-05 - Abnormal Global Electrical Heterogeneity Is Associated With Sustained Ventricular Tachyarrhythmias And Appropriate Implantable Cardioverter-defibrillator Therapies In Primary Prevention Patients (ID 1418)
Authors
- Jonathan W. Waks
- Larisa G. Tereshchenko
- Albert J. Rogers
- Ashkan Ehdaie
- Christine Tompkins
- Khidir Dalouk
- Stacey Howell
- Aron Bender
- Kazi T. Haq
- Nichole Rogovoy
- Christopher Hamilton
- Katherine Yang
- Erick Perez-Alday
- Achille Peiris
- Zachary Zouyed
- Jessica Minnier
- Merritt H. Raitt
- Sanjiv M. Narayan
- Sumeet S. Chugh
Abstract
Background: Global electrical heterogeneity (GEH) has been shown associated with sudden cardiac death in the general population.
Objective: To determine if GEH is associated with sustained ventricular tachyarrhythmia (VT) and appropriate implantable cardioverter-defibrillator (ICD) therapies in patients with primary prevention ICD.
Methods: We conducted a multicenter retrospective cohort study. Baseline ECGs of primary prevention ICD recipients (n=2,447; age 63±12y; 24% female; 73% white; 44% ischemic cardiomyopathy; ejection fraction (EF) 28±12%; NYHA class 2.3±0.8; 35% diabetes; 68% hypertension; 44% single-chamber ICD) in six diverse US centers were analyzed. Abnormal GEH was detected if any of the GEH metrics exceeded thresholds previously defined in the general population. Adjudicated sustained VT with appropriate ICD therapies served as the outcome.
Results: During the median 3 years of follow-up, there were 471 sustained VT events with appropriate ICD therapies. Patients with abnormal GEH experienced a higher VT incidence (0.15; 95%CI 0.14-0.16 /1000 person-years) than those with normal GEH (0.06; 95%CI 0.03-0.12 /1000 person-years; Figure). In Cox regression analysis, after adjustment for age, sex, race, study center, cardiomyopathy type, history of revascularization, diabetes, hypertension, atrial fibrillation (AF), use of antiarrhythmic drugs, ACEi/ARBs, beta-blockers, NYHA class, EF, ICD device type, and median beat type (N, AF, VP), abnormal GEH was associated with the outcome (HR 2.80; 95%CI 1.04-7.54; P=0.042).
Conclusion: Abnormal GEH is independently associated with sustained VT and appropriate ICD therapies in primary prevention ICD patients.
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Objective: To determine if GEH is associated with sustained ventricular tachyarrhythmia (VT) and appropriate implantable cardioverter-defibrillator (ICD) therapies in patients with primary prevention ICD.
Methods: We conducted a multicenter retrospective cohort study. Baseline ECGs of primary prevention ICD recipients (n=2,447; age 63±12y; 24% female; 73% white; 44% ischemic cardiomyopathy; ejection fraction (EF) 28±12%; NYHA class 2.3±0.8; 35% diabetes; 68% hypertension; 44% single-chamber ICD) in six diverse US centers were analyzed. Abnormal GEH was detected if any of the GEH metrics exceeded thresholds previously defined in the general population. Adjudicated sustained VT with appropriate ICD therapies served as the outcome.
Results: During the median 3 years of follow-up, there were 471 sustained VT events with appropriate ICD therapies. Patients with abnormal GEH experienced a higher VT incidence (0.15; 95%CI 0.14-0.16 /1000 person-years) than those with normal GEH (0.06; 95%CI 0.03-0.12 /1000 person-years; Figure). In Cox regression analysis, after adjustment for age, sex, race, study center, cardiomyopathy type, history of revascularization, diabetes, hypertension, atrial fibrillation (AF), use of antiarrhythmic drugs, ACEi/ARBs, beta-blockers, NYHA class, EF, ICD device type, and median beat type (N, AF, VP), abnormal GEH was associated with the outcome (HR 2.80; 95%CI 1.04-7.54; P=0.042).
Conclusion: Abnormal GEH is independently associated with sustained VT and appropriate ICD therapies in primary prevention ICD patients.
