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. 2022 Jan;8(1):1-11.
doi: 10.1016/j.jacep.2021.06.020. Epub 2021 Aug 25.

Arrhythmic and Mortality Outcomes Among Ischemic Versus Nonischemic Cardiomyopathy Patients Receiving Primary ICD Therapy

Craig R Narins  1 , Mehmet K Aktas  2 , Anita Y Chen  3 , Scott McNitt  4 , Fred S Ling  2 , Arwa Younis  4 , Wojciech Zareba  5 , James P Daubert  6 , David T Huang  2 , Spencer Rosero  2 , Valentina Kutyifa  5 , Ilan Goldenberg  5
Affiliations

Arrhythmic and Mortality Outcomes Among Ischemic Versus Nonischemic Cardiomyopathy Patients Receiving Primary ICD Therapy

Craig R Narins et al. JACC Clin Electrophysiol. 2022 Jan.

Abstract

Objectives: This study sought to determine the association of cardiomyopathy etiology with the likelihood of ventricular arrhythmias, appropriate implantable cardioverter-defibrillator (ICD) therapy, and mortality.

Background: There are conflicting data on the benefit of primary prevention ICD therapy in patients with ischemic versus nonischemic cardiomyopathy (ICM/NICM).

Methods: The study population comprised 4803 patients with ICM (n = 3,106) or NICM (n = 1,697) with a primary prevention ICD enrolled in 5 randomized trials conducted between 1997 and 2017. The primary end point was sustained ventricular tachycardia (VT) ≥200 beats/min or ventricular fibrillation (VF). Secondary end points included appropriate ICD therapy and all-cause mortality. Differences in cause-specific mortality, including noncardiac, sudden cardiac, and non-sudden cardiac death, were also examined.

Results: Patients with ICM were significantly older and had more comorbid conditions, whereas those with NICM had a more advanced heart failure class at enrollment and were more often prescribed medical or cardiac resynchronization therapy for heart failure. Multivariate analysis showed that ICM versus NICM had a similar risk of VT/VF events (HR: 0.98 [95% CI: 0.79-1.20]) and appropriate ICD therapy (HR: 1.03 [95% CI: 0.87-1.22]), whereas the risk of all-cause mortality was 1.8-fold higher among ICM versus NICM patients (HR: 1.84 [95% CI: 1.42-2.38]), dominated by non-sudden cardiac mortality.

Conclusions: Combined data from 5 landmark ICD clinical trials show that ICM patients experience a similar risk of life-threatening ventricular arrhythmic events but have an increased risk of all-cause mortality, dominated by non-sudden cardiac death, compared with NICM patients.

Keywords: cardiomyopathies; implantable defibrillators; sudden death; ventricular arrhythmias.

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Conflict of interest statement

Funding Support and Author Disclosures Each of the MADIT trials were funded by an unrestricted research grant from Boston Scientific to the University of Rochester Medical Center, Rochester, NY. The RAID trial was funded by the National Institutes of Health (NIH) grant U01HL096607. Dr Aktas has received research grants from Boston Scientific and Medtronic. Dr Zareba has received research grants from Boston Scientific, LevaNova, Biotronik, and Gilead Sciences; and has been a consultant for Medtronic, Abbott, and Astra-Zeneca. Dr Daubert has received honoraria for serving on events committees, data safety monitoring boards, and advisory boards, as a consultant, and/or for lectures from Abbott, Biosense, Biotronik, Boston Scientific, Farapulse, Medtronic, Microport, Phillips, Vytronus, and Zoll; and has received research grants from Abbott and Medtronic. Dr Huang has received research support from Biosense Webster, Biotronik, and Medtronic; and has received Fellowship Program support from Boston Scientific, Medtronic, Abbott, and Biotronik. Dr Rosero has received research grants from Medtronic, Biotronik, and Spire Inc. Dr Kutyifa has received research grants from Boston Scientific, Biotronik, ZOLL Inc., and Spire Inc.; and has consultant agreements with Zoll Inc. and Biotronik. Dr Goldenberg has received research grants from Boston Scientific, Zoll, Medtronic, Biosense Webster, and Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

Figure 1 –
Figure 1 –
Patient population included in the present study.
Figure 2 –
Figure 2 –
Observed cumulative incidences of (A) ventricular tachycardia ≥170 bpm or ventricular fibrillation, and (B) appropriate ICD therapy (anti-tachycardia pacing or shock) in patients with ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM)
Figure 3 –
Figure 3 –
Adjusted Cumulative Incidences of (A) Ventricular Tachycardia ≥200 bpm or Ventricular Fibrillation and (B) All-cause Mortality in Patients with Ischemic versus Non-ischemic Cardiomyopathy
Figure 4 –
Figure 4 –
Unadjusted Kaplan-Meier estimates of the cumulative probabilities of heart failure or all-cause mortality in patients with ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM)
Figure 5 –
Figure 5 –
Incidences of all-cause mortality and cause-specific mortality at 3.5-year follow-up in patients with ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM)
Central Figure –
Central Figure –
(A) Observed cumulative incidences of ventricular tachycardia ≥200 bpm or ventricular fibrillation, and (B) unadjusted Kaplan-Meier estimates of the cumulative probabilities of all-cause mortality in patients with ischemic cardiomyopathy (ICM) and non-ischemic cardiomyopathy (NICM)
See this image and copyright information in PMC

Comment in

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