Cargando…

Right ventricular function is a predictor for sustained ventricular tachycardia requiring anti-tachycardic pacing in arrhythmogenic ventricular cardiomyopathy: insight into transvenous vs. subcutaneous implantable cardioverter defibrillator insertion

AIMS: Arrhythmogenic right ventricular cardiomyopathy (ARVC) patients develop ventricular arrhythmias (VAs) responsive to anti-tachycardia pacing (ATP). However, VA episodes have not been characterized in accordance with the device therapy, and with the emergence of the subcutaneous implantable card...

Descripción completa

Detalles Bibliográficos
Autores principales: Honarbakhsh, Shohreh, Protonotarios, Alexander, Monkhouse, Christopher, Hunter, Ross J, Elliott, Perry M, Lambiase, Pier D
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10202497/
https://www.ncbi.nlm.nih.gov/pubmed/37213071
http://dx.doi.org/10.1093/europace/euad073
_version_ 1785045446317572096
author Honarbakhsh, Shohreh
Protonotarios, Alexander
Monkhouse, Christopher
Hunter, Ross J
Elliott, Perry M
Lambiase, Pier D
author_facet Honarbakhsh, Shohreh
Protonotarios, Alexander
Monkhouse, Christopher
Hunter, Ross J
Elliott, Perry M
Lambiase, Pier D
author_sort Honarbakhsh, Shohreh
collection PubMed
description AIMS: Arrhythmogenic right ventricular cardiomyopathy (ARVC) patients develop ventricular arrhythmias (VAs) responsive to anti-tachycardia pacing (ATP). However, VA episodes have not been characterized in accordance with the device therapy, and with the emergence of the subcutaneous implantable cardioverter defibrillator (S-ICD), the appropriate device prescription in ARVC remains unclear. Study aim was to characterize VA events in ARVC patients during follow-up in accordance with device therapy and elicit if certain parameters are predictive of specific VA events. METHODS AND RESULTS: This was a retrospective single-centre study utilizing prospectively collated registry data of ARVC patients with ICDs. Forty-six patients were included [54.0 ± 12.1 years old and 20 (43.5%) secondary prevention devices]. During a follow-up of 12.1 ± 6.9 years, 31 (67.4%) patients had VA events [n = 2, 6.5% ventricular fibrillation (VF), n = 14], 45.2% VT falling in VF zone resulting in ICD shock(s), n = 10, 32.3% VT resulting in ATP, and n = 5, 16.1% patients had both VT resulting in ATP and ICD shock(s). Lead failure rates were high (11/46, 23.9%). ATP was successful in 34.5% of patients. Severely impaired right ventricular (RV) function was an independent predictor of VT resulting in ATP (hazard ratio 16.80, 95% confidence interval 3.74–75.2; P < 0.001) with a high predictive accuracy (area under the curve 0.88, 95%CI 0.76–1.00; P < 0.001). CONCLUSION: VA event rates are high in ARVC patients with a majority having VT falling in the VF zone resulting in ICD shock(s). S-ICDs could be of benefit in most patients with ARVC with the absence of severely impaired RV function which has the potential to avoid consequences of the high burden of lead failure.
format Online
Article
Text
id pubmed-10202497
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-102024972023-05-23 Right ventricular function is a predictor for sustained ventricular tachycardia requiring anti-tachycardic pacing in arrhythmogenic ventricular cardiomyopathy: insight into transvenous vs. subcutaneous implantable cardioverter defibrillator insertion Honarbakhsh, Shohreh Protonotarios, Alexander Monkhouse, Christopher Hunter, Ross J Elliott, Perry M Lambiase, Pier D Europace Clinical Research AIMS: Arrhythmogenic right ventricular cardiomyopathy (ARVC) patients develop ventricular arrhythmias (VAs) responsive to anti-tachycardia pacing (ATP). However, VA episodes have not been characterized in accordance with the device therapy, and with the emergence of the subcutaneous implantable cardioverter defibrillator (S-ICD), the appropriate device prescription in ARVC remains unclear. Study aim was to characterize VA events in ARVC patients during follow-up in accordance with device therapy and elicit if certain parameters are predictive of specific VA events. METHODS AND RESULTS: This was a retrospective single-centre study utilizing prospectively collated registry data of ARVC patients with ICDs. Forty-six patients were included [54.0 ± 12.1 years old and 20 (43.5%) secondary prevention devices]. During a follow-up of 12.1 ± 6.9 years, 31 (67.4%) patients had VA events [n = 2, 6.5% ventricular fibrillation (VF), n = 14], 45.2% VT falling in VF zone resulting in ICD shock(s), n = 10, 32.3% VT resulting in ATP, and n = 5, 16.1% patients had both VT resulting in ATP and ICD shock(s). Lead failure rates were high (11/46, 23.9%). ATP was successful in 34.5% of patients. Severely impaired right ventricular (RV) function was an independent predictor of VT resulting in ATP (hazard ratio 16.80, 95% confidence interval 3.74–75.2; P < 0.001) with a high predictive accuracy (area under the curve 0.88, 95%CI 0.76–1.00; P < 0.001). CONCLUSION: VA event rates are high in ARVC patients with a majority having VT falling in the VF zone resulting in ICD shock(s). S-ICDs could be of benefit in most patients with ARVC with the absence of severely impaired RV function which has the potential to avoid consequences of the high burden of lead failure. Oxford University Press 2023-05-22 /pmc/articles/PMC10202497/ /pubmed/37213071 http://dx.doi.org/10.1093/europace/euad073 Text en © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Clinical Research
Honarbakhsh, Shohreh
Protonotarios, Alexander
Monkhouse, Christopher
Hunter, Ross J
Elliott, Perry M
Lambiase, Pier D
Right ventricular function is a predictor for sustained ventricular tachycardia requiring anti-tachycardic pacing in arrhythmogenic ventricular cardiomyopathy: insight into transvenous vs. subcutaneous implantable cardioverter defibrillator insertion
title Right ventricular function is a predictor for sustained ventricular tachycardia requiring anti-tachycardic pacing in arrhythmogenic ventricular cardiomyopathy: insight into transvenous vs. subcutaneous implantable cardioverter defibrillator insertion
title_full Right ventricular function is a predictor for sustained ventricular tachycardia requiring anti-tachycardic pacing in arrhythmogenic ventricular cardiomyopathy: insight into transvenous vs. subcutaneous implantable cardioverter defibrillator insertion
title_fullStr Right ventricular function is a predictor for sustained ventricular tachycardia requiring anti-tachycardic pacing in arrhythmogenic ventricular cardiomyopathy: insight into transvenous vs. subcutaneous implantable cardioverter defibrillator insertion
title_full_unstemmed Right ventricular function is a predictor for sustained ventricular tachycardia requiring anti-tachycardic pacing in arrhythmogenic ventricular cardiomyopathy: insight into transvenous vs. subcutaneous implantable cardioverter defibrillator insertion
title_short Right ventricular function is a predictor for sustained ventricular tachycardia requiring anti-tachycardic pacing in arrhythmogenic ventricular cardiomyopathy: insight into transvenous vs. subcutaneous implantable cardioverter defibrillator insertion
title_sort right ventricular function is a predictor for sustained ventricular tachycardia requiring anti-tachycardic pacing in arrhythmogenic ventricular cardiomyopathy: insight into transvenous vs. subcutaneous implantable cardioverter defibrillator insertion
topic Clinical Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10202497/
https://www.ncbi.nlm.nih.gov/pubmed/37213071
http://dx.doi.org/10.1093/europace/euad073
work_keys_str_mv AT honarbakhshshohreh rightventricularfunctionisapredictorforsustainedventriculartachycardiarequiringantitachycardicpacinginarrhythmogenicventricularcardiomyopathyinsightintotransvenousvssubcutaneousimplantablecardioverterdefibrillatorinsertion
AT protonotariosalexander rightventricularfunctionisapredictorforsustainedventriculartachycardiarequiringantitachycardicpacinginarrhythmogenicventricularcardiomyopathyinsightintotransvenousvssubcutaneousimplantablecardioverterdefibrillatorinsertion
AT monkhousechristopher rightventricularfunctionisapredictorforsustainedventriculartachycardiarequiringantitachycardicpacinginarrhythmogenicventricularcardiomyopathyinsightintotransvenousvssubcutaneousimplantablecardioverterdefibrillatorinsertion
AT hunterrossj rightventricularfunctionisapredictorforsustainedventriculartachycardiarequiringantitachycardicpacinginarrhythmogenicventricularcardiomyopathyinsightintotransvenousvssubcutaneousimplantablecardioverterdefibrillatorinsertion
AT elliottperrym rightventricularfunctionisapredictorforsustainedventriculartachycardiarequiringantitachycardicpacinginarrhythmogenicventricularcardiomyopathyinsightintotransvenousvssubcutaneousimplantablecardioverterdefibrillatorinsertion
AT lambiasepierd rightventricularfunctionisapredictorforsustainedventriculartachycardiarequiringantitachycardicpacinginarrhythmogenicventricularcardiomyopathyinsightintotransvenousvssubcutaneousimplantablecardioverterdefibrillatorinsertion