Clustering of ventricular tachyarrhythmias in heart failure patients implanted with a biventricular cardioverter defibrillator

Maurizio Lunati, Maurizio Gasparini, Mario Bocchiardo, Antonio Curnis, Maurizio Landolina, Angelo Carboni, Gianni Luzzi, Gabriele Zanotto, Pierantonio Ravazzi, Giovanni Magenta, Alessandra Denaro, Paola Distefano, Andrea Grammatico

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Temporal patterns of ventricular tachyarrhythmia (VT/VF) have been studied only in patients who have received implantable cardioverter defibrillators (ICD) for secondary prevention of sudden death, and mainly in ischemic patients. The aim of this study was to evaluate VT/VF recurrence patterns in heart failure (HF) patients with biventricular ICD and to stratify results according to HF etiology and ICD indication. Methods and Results: We studied 421 patients (91% male, 66 ± 9 years). HF etiology was ischemic in 292 patients and nonischemic in 129. ICD indication was for primary prevention in 227 patients and secondary prevention in 194. Baseline left ventricular ejection fraction (LVEF) was 26 ± 7%, QRS duration 168 ± 32 msec, and NYHA class 2.9 ± 0.6. In a follow-up of 19 ± 11 months, 1,838 VT/VF in 110 patients were appropriately detected. In 59 patients who had ≥4 episodes, we tried to determine whether VT/VF occurred randomly or rather tended to cluster by fitting the frequency distribution of tachycardia interdetection intervals with exponential functions: VT/VF clusters were observed in 46 patients (78% of the subgroup of patients with ≥4 episodes and 11% of the overall population). On multivariate logistic analysis, VT/VF clusters were significantly (P <0.01) associated with ICD indication for secondary prevention (odds ratio [OR] = 3.12; confidence interval [CI] = 1.56-6.92), nonischemic HF etiology (OR = 4.34; CI = 2.02-9.32), monomorphic VT (OR = 4.96; CI = 2.28-10.8), and LVEF <25% (OR = 3.34; CI = 1.54-7.23). Cardiovascular hospitalizations and deaths occurred more frequently in cluster (21/46 [46%]) than in noncluster patients (63/375 (17%), P <0.0001). Conclusions: In HF patients with biventricular ICDs, VT/VF clusters may be regarded as the epiphenomenon of HF deterioration or as a marker of suboptimal response to cardiac resynchronization therapy.

Original languageEnglish
Pages (from-to)1299-1306
Number of pages8
JournalJournal of Cardiovascular Electrophysiology
Volume17
Issue number12
DOIs
Publication statusPublished - Dec 2006

Fingerprint

Defibrillators
Tachycardia
Cluster Analysis
Heart Failure
Implantable Defibrillators
Secondary Prevention
Odds Ratio
Confidence Intervals
Stroke Volume
Cardiac Resynchronization Therapy
Primary Prevention
Sudden Death
Hospitalization
Multivariate Analysis

Keywords

  • Defibrillation
  • Ischemic and nonischemic heart failure etiology
  • Primary and secondary prevention
  • Ventricular tachyarrhythmia clusters

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Clustering of ventricular tachyarrhythmias in heart failure patients implanted with a biventricular cardioverter defibrillator. / Lunati, Maurizio; Gasparini, Maurizio; Bocchiardo, Mario; Curnis, Antonio; Landolina, Maurizio; Carboni, Angelo; Luzzi, Gianni; Zanotto, Gabriele; Ravazzi, Pierantonio; Magenta, Giovanni; Denaro, Alessandra; Distefano, Paola; Grammatico, Andrea.

In: Journal of Cardiovascular Electrophysiology, Vol. 17, No. 12, 12.2006, p. 1299-1306.

Research output: Contribution to journalArticle

Lunati, M, Gasparini, M, Bocchiardo, M, Curnis, A, Landolina, M, Carboni, A, Luzzi, G, Zanotto, G, Ravazzi, P, Magenta, G, Denaro, A, Distefano, P & Grammatico, A 2006, 'Clustering of ventricular tachyarrhythmias in heart failure patients implanted with a biventricular cardioverter defibrillator', Journal of Cardiovascular Electrophysiology, vol. 17, no. 12, pp. 1299-1306. https://doi.org/10.1111/j.1540-8167.2006.00618.x
Lunati, Maurizio ; Gasparini, Maurizio ; Bocchiardo, Mario ; Curnis, Antonio ; Landolina, Maurizio ; Carboni, Angelo ; Luzzi, Gianni ; Zanotto, Gabriele ; Ravazzi, Pierantonio ; Magenta, Giovanni ; Denaro, Alessandra ; Distefano, Paola ; Grammatico, Andrea. / Clustering of ventricular tachyarrhythmias in heart failure patients implanted with a biventricular cardioverter defibrillator. In: Journal of Cardiovascular Electrophysiology. 2006 ; Vol. 17, No. 12. pp. 1299-1306.
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abstract = "Background: Temporal patterns of ventricular tachyarrhythmia (VT/VF) have been studied only in patients who have received implantable cardioverter defibrillators (ICD) for secondary prevention of sudden death, and mainly in ischemic patients. The aim of this study was to evaluate VT/VF recurrence patterns in heart failure (HF) patients with biventricular ICD and to stratify results according to HF etiology and ICD indication. Methods and Results: We studied 421 patients (91{\%} male, 66 ± 9 years). HF etiology was ischemic in 292 patients and nonischemic in 129. ICD indication was for primary prevention in 227 patients and secondary prevention in 194. Baseline left ventricular ejection fraction (LVEF) was 26 ± 7{\%}, QRS duration 168 ± 32 msec, and NYHA class 2.9 ± 0.6. In a follow-up of 19 ± 11 months, 1,838 VT/VF in 110 patients were appropriately detected. In 59 patients who had ≥4 episodes, we tried to determine whether VT/VF occurred randomly or rather tended to cluster by fitting the frequency distribution of tachycardia interdetection intervals with exponential functions: VT/VF clusters were observed in 46 patients (78{\%} of the subgroup of patients with ≥4 episodes and 11{\%} of the overall population). On multivariate logistic analysis, VT/VF clusters were significantly (P <0.01) associated with ICD indication for secondary prevention (odds ratio [OR] = 3.12; confidence interval [CI] = 1.56-6.92), nonischemic HF etiology (OR = 4.34; CI = 2.02-9.32), monomorphic VT (OR = 4.96; CI = 2.28-10.8), and LVEF <25{\%} (OR = 3.34; CI = 1.54-7.23). Cardiovascular hospitalizations and deaths occurred more frequently in cluster (21/46 [46{\%}]) than in noncluster patients (63/375 (17{\%}), P <0.0001). Conclusions: In HF patients with biventricular ICDs, VT/VF clusters may be regarded as the epiphenomenon of HF deterioration or as a marker of suboptimal response to cardiac resynchronization therapy.",
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AU - Lunati, Maurizio

AU - Gasparini, Maurizio

AU - Bocchiardo, Mario

AU - Curnis, Antonio

AU - Landolina, Maurizio

AU - Carboni, Angelo

AU - Luzzi, Gianni

AU - Zanotto, Gabriele

AU - Ravazzi, Pierantonio

AU - Magenta, Giovanni

AU - Denaro, Alessandra

AU - Distefano, Paola

AU - Grammatico, Andrea

PY - 2006/12

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N2 - Background: Temporal patterns of ventricular tachyarrhythmia (VT/VF) have been studied only in patients who have received implantable cardioverter defibrillators (ICD) for secondary prevention of sudden death, and mainly in ischemic patients. The aim of this study was to evaluate VT/VF recurrence patterns in heart failure (HF) patients with biventricular ICD and to stratify results according to HF etiology and ICD indication. Methods and Results: We studied 421 patients (91% male, 66 ± 9 years). HF etiology was ischemic in 292 patients and nonischemic in 129. ICD indication was for primary prevention in 227 patients and secondary prevention in 194. Baseline left ventricular ejection fraction (LVEF) was 26 ± 7%, QRS duration 168 ± 32 msec, and NYHA class 2.9 ± 0.6. In a follow-up of 19 ± 11 months, 1,838 VT/VF in 110 patients were appropriately detected. In 59 patients who had ≥4 episodes, we tried to determine whether VT/VF occurred randomly or rather tended to cluster by fitting the frequency distribution of tachycardia interdetection intervals with exponential functions: VT/VF clusters were observed in 46 patients (78% of the subgroup of patients with ≥4 episodes and 11% of the overall population). On multivariate logistic analysis, VT/VF clusters were significantly (P <0.01) associated with ICD indication for secondary prevention (odds ratio [OR] = 3.12; confidence interval [CI] = 1.56-6.92), nonischemic HF etiology (OR = 4.34; CI = 2.02-9.32), monomorphic VT (OR = 4.96; CI = 2.28-10.8), and LVEF <25% (OR = 3.34; CI = 1.54-7.23). Cardiovascular hospitalizations and deaths occurred more frequently in cluster (21/46 [46%]) than in noncluster patients (63/375 (17%), P <0.0001). Conclusions: In HF patients with biventricular ICDs, VT/VF clusters may be regarded as the epiphenomenon of HF deterioration or as a marker of suboptimal response to cardiac resynchronization therapy.

AB - Background: Temporal patterns of ventricular tachyarrhythmia (VT/VF) have been studied only in patients who have received implantable cardioverter defibrillators (ICD) for secondary prevention of sudden death, and mainly in ischemic patients. The aim of this study was to evaluate VT/VF recurrence patterns in heart failure (HF) patients with biventricular ICD and to stratify results according to HF etiology and ICD indication. Methods and Results: We studied 421 patients (91% male, 66 ± 9 years). HF etiology was ischemic in 292 patients and nonischemic in 129. ICD indication was for primary prevention in 227 patients and secondary prevention in 194. Baseline left ventricular ejection fraction (LVEF) was 26 ± 7%, QRS duration 168 ± 32 msec, and NYHA class 2.9 ± 0.6. In a follow-up of 19 ± 11 months, 1,838 VT/VF in 110 patients were appropriately detected. In 59 patients who had ≥4 episodes, we tried to determine whether VT/VF occurred randomly or rather tended to cluster by fitting the frequency distribution of tachycardia interdetection intervals with exponential functions: VT/VF clusters were observed in 46 patients (78% of the subgroup of patients with ≥4 episodes and 11% of the overall population). On multivariate logistic analysis, VT/VF clusters were significantly (P <0.01) associated with ICD indication for secondary prevention (odds ratio [OR] = 3.12; confidence interval [CI] = 1.56-6.92), nonischemic HF etiology (OR = 4.34; CI = 2.02-9.32), monomorphic VT (OR = 4.96; CI = 2.28-10.8), and LVEF <25% (OR = 3.34; CI = 1.54-7.23). Cardiovascular hospitalizations and deaths occurred more frequently in cluster (21/46 [46%]) than in noncluster patients (63/375 (17%), P <0.0001). Conclusions: In HF patients with biventricular ICDs, VT/VF clusters may be regarded as the epiphenomenon of HF deterioration or as a marker of suboptimal response to cardiac resynchronization therapy.

KW - Defibrillation

KW - Ischemic and nonischemic heart failure etiology

KW - Primary and secondary prevention

KW - Ventricular tachyarrhythmia clusters

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