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Prognostic impact of coronary chronic total occlusion on recurrences of ventricular tachyarrhythmias and ICD therapies

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Abstract

Background

Despite a few studies evaluating the prognostic impact of coronary chronic total occlusion (CTO) in implantable cardioverter defibrillator (ICD) recipients, the impact of CTO on different types of recurrences of ventricular tachyarrhythmias, as well as their predictors has not yet been investigated in CTO patients.

Methods

A large retrospective registry was used including all consecutive patients with ventricular tachyarrhythmias undergoing coronary angiography at index from 2002 to 2016. Only ICD recipients with CTO were compared to patients without (non-CTO). Kaplan–Meier and Cox regression analyses were applied for the primary end point of first recurrence of ventricular tachyarrhythmias at 5 years. Secondary end points comprised of the different types of recurrences, first appropriate ICD therapy and all-cause mortality at 5 years.

Results

From a total of 422 consecutive ICD recipients with ventricular tachyarrhythmias at index, at least one CTO was present in 25%. CTO was associated with the primary end point of first recurrence of ventricular tachyarrhythmias at 5 years (55% vs. 39%; log rank p = 0.001; HR = 1.665; 95% CI 1.221–2.271; p = 0.001), as well as increased risk of first appropriate ICD therapy (40% vs. 31%; log rank p = 0.039; HR = 1.454; 95% CI 1.016–2.079; p = 0.041) and all-cause mortality at 5 years (26% vs. 16%; log rank p = 0.011; HR = 1.797; 95% CI 1.133–2.850; p = 0.013). Less developed collaterals (i.e., either ipsi- or contralateral compared to bilateral) and a J-CTO score ≥ 3 were strongest predictors of recurrences in CTO patients at 5 years.

Conclusion

A coronary CTO even in the presence of less developed collaterals and more complex CTO category is associated with increasing risk of recurrent ventricular tachyarrhythmias at 5 years in consecutive ICD recipients.

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Authors and Affiliations

  1. First Department of Medicine, Faculty of Medicine Mannheim, University Medical Centre Mannheim (UMM), University of Heidelberg, DZHK (German Center for Cardiovascular Research) Partner Site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany

    Michael Behnes, Philipp Kuche, Seung-hyun Kim, Tobias Schupp, Max von Zworowsky, Linda Reiser, Armin Bollow, Gabriel Taton, Thomas Reichelt, Martin Borggrefe, Dominik Ellguth, Niko Engelke, Kathrin Weidner, Simon Lindner, Julian Müller, Uzair Ansari, Siegfried Lang & Ibrahim Akin

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

    Kambis Mashayekhi

  3. Department of Cardiology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany

    Dirk Große Meininghaus

  4. Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, General Hospital Nuremberg, Paracelsus Medical University, Nuremberg, Germany

    Thomas Bertsch

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  1. Michael Behnes
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Correspondence to Michael Behnes.

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Behnes, M., Mashayekhi, K., Kuche, P. et al. Prognostic impact of coronary chronic total occlusion on recurrences of ventricular tachyarrhythmias and ICD therapies. Clin Res Cardiol 110, 281–291 (2021). https://doi.org/10.1007/s00392-020-01758-y

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  • DOI: https://doi.org/10.1007/s00392-020-01758-y

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