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Primary prevention with the implantable cardioverter-defibrillator in high-risk long-QT syndrome patients.

ABSTRACT: Aims:Prospective data regarding the role of implantable cardioverter-defibrillator (ICD) for the primary prevention of sudden cardiac death in patients with long QT syndrome (LQTS) is scarce. Herein, we explore the prospective Rochester LQTS ICD registry to assess the risk for appropriate shock in primary prevention in a real-world setting. Methods and results:We studied 212 LQTS patients that had ICD implantation for primary prevention. Best-subsets proportional-hazards regression analysis was used to identify clinical variables that were associated with the first appropriate shock. Conditional models of Prentice, Williams, and Peterson were utilized for the analysis of recurrent appropriate shocks. During a median follow-up of 9.2?±?4.9?years, there were 42 patients who experienced at least one appropriate shock and the cumulative probability of appropriate shock at 8?years was 22%. QTc???550 ms [hazard ratio (HR) 3.94, confidence interval (CI) 2.08-7.46; P?

SUBMITTER: Biton Y

PROVIDER: S-EPMC6365807 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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Primary prevention with the implantable cardioverter-defibrillator in high-risk long-QT syndrome patients.

Biton Yitschak Y Rosero Spencer S Moss Arthur J AJ Goldenberg Ilan I Kutyifa Valentina V McNitt Scott S Polonsky Bronislava B Baman Jayson R JR Zareba Wojciech W

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 20190201 2

<h4>Aims</h4>Prospective data regarding the role of implantable cardioverter-defibrillator (ICD) for the primary prevention of sudden cardiac death in patients with long QT syndrome (LQTS) is scarce. Herein, we explore the prospective Rochester LQTS ICD registry to assess the risk for appropriate shock in primary prevention in a real-world setting.<h4>Methods and results</h4>We studied 212 LQTS patients that had ICD implantation for primary prevention. Best-subsets proportional-hazards regressio ...[more]

PMID: 29947754

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Project description:Background One third of primary prevention implantable cardioverter-defibrillator patients receive appropriate therapy, but all remain at risk of defibrillator complications. Information on these complications in contemporary cohorts is limited. This study assessed complications and their risk factors after defibrillator implantation in a Dutch nationwide prospective registry cohort and forecasts the potential reduction in complications under distinct scenarios of updated indication criteria. Methods and Results Complications in a prospective multicenter registry cohort of 1442 primary implantable cardioverter-defibrillator implant patients were classified as major or minor. The potential for reducing complications was derived from a newly developed prediction model of appropriate therapy to identify patients with a low probability of benefitting from the implantable cardioverter-defibrillator. During a follow-up of 2.2 years (interquartile range, 2.0-2.6 years), 228 complications occurred in 195 patients (13.6%), with 113 patients (7.8%) experiencing at least one major complication. Most common ones were lead related (n=93) and infection (n=18). Minor complications occurred in 6.8% of patients, with lead-related (n=47) and pocket-related (n=40) complications as the most prevailing ones. A surgical reintervention or additional hospitalization was required in 53% or 61% of complications, respectively. Complications were strongly associated with device type. Application of stricter implant indication results in a comparable proportional reduction of (major) complications. Conclusions One in 13 patients experiences at least one major implantable cardioverter-defibrillator-related complication, and many patients undergo a surgical reintervention. Complications are related to defibrillator implantations, and these should be discussed with the patient. Stricter implant indication criteria and careful selection of device type implanted may have significant clinical and financial benefits.

Dataset Information

Primary prevention with the implantable cardioverter-defibrillator in high-risk long-QT syndrome patients.

Publications

Primary prevention with the implantable cardioverter-defibrillator in high-risk long-QT syndrome patients.

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