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Prognostic impact of recurrences of ventricular tachyarrhythmias and appropriate ICD therapies in a high-risk ICD population

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Abstract

Purpose

The study sought to evaluate the prognostic impact of recurrences of ventricular tachyarrhythmias in consecutive ICD recipients with ventricular tachyarrhythmias on admission.

Methods

All consecutive patients surviving at least one episode of ventricular tachyarrhythmias from 2002 to 2016 and discharged with an ICD (pre-existing ICD or ICD implantation at index hospitalization) were included. The primary endpoint was all-cause mortality according to the presence or absence of recurrences of ventricular tachyarrhythmias at 5 years. Secondary endpoints comprised the impact of different types of recurrences, appropriate ICD therapies, as well as predictors of recurrences and appropriate ICD therapies. Kaplan–Meier, multivariable Cox regression and propensity score matching analyses were applied.

Results

A total of 592 consecutive ICD recipients was included (44% with recurrences of ventricular tachyarrhythmias and 56% without). Recurrences of ventricular tachyarrhythmias were associated with increased all-cause mortality at 5 years (HR = 1.498; 95% CI = 1.052–2.132; p = 0.025). Worst survival was observed in patients with sustained VT or VF as first recurrences compared to non-sustained VT, as well as in patients with cumulative recurrences of non-sustained or sustained VT plus VF, whereas mortality was not affected by the number of recurrences of ventricular tachyarrhythmias (> 4 vs. ≤ 4). Moreover, appropriate ICD therapies were associated with increased all-cause mortality (HR = 1.874; 95% CI = 1.318–2.666; p = 0.001), mainly attributed to secondary preventive ICDs. Finally, atrial fibrillation, LVEF < 35% and non-ischemic cardiomyopathy were identified as predictors of recurrences of ventricular tachyarrhythmias and appropriate ICD therapies.

Conclusions

Recurrences of ventricular tachyarrhythmias and recurrent appropriate ICD therapies are associated with increased long-term all-cause mortality in consecutive ICD recipients. Non-ischemic cardiomyopathy, AF and LVEF < 35% revealed to be significant predictors of both endpoints.

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Author notes

  1. Tobias Schupp and Ibrahim Akin contributed equally to this study.

Authors and Affiliations

  1. First Department of Medicine, Faculty of Medicine Mannheim, European Center for AngioScience (ECAS), and DZHK, University Medical Centre Mannheim (UMM), University of Heidelberg, German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Tobias Schupp, Ibrahim Akin, Linda Reiser, Armin Bollow, Gabriel Taton, Thomas Reichelt, Dominik Ellguth, Niko Engelke, Uzair Ansari, Martin Borggrefe & Michael Behnes

  2. Department of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen, Germany

    Kambis Mashayekhi

  3. Institute of Biomathematics and Medical Statistics, Faculty of Medicine Mannheim, University Medical Center Mannheim (UMM), Heidelberg University, Mannheim, Germany

    Christel Weiß

  4. Royal Brompton and Harefield Hospitals, NHS, London, UK

    Christoph Nienaber

  5. Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany

    Muharrem Akin

Authors
  1. Tobias Schupp
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  2. Ibrahim Akin
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  3. Linda Reiser
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Correspondence to Michael Behnes.

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Schupp, T., Akin, I., Reiser, L. et al. Prognostic impact of recurrences of ventricular tachyarrhythmias and appropriate ICD therapies in a high-risk ICD population. Clin Res Cardiol 108, 878–891 (2019). https://doi.org/10.1007/s00392-019-01416-y

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