Long-term outcomes after prophylactic ICD and CRT-D implantation in nonischemic patients: Analysis from a nationwide database of daily remote-monitoring transmissions

Giovanni B. Forleo, Francesco Solimene, Ennio C. Pisanò, Gabriele Zanotto, Valeria Calvi, Carlo Pignalberi, Giampiero Maglia, Saverio Iacopino, Fabio Quartieri, Mauro Biffi, Fabrizio Caravati, Antonio Curnis, Alessandro Capucci, Gaetano Senatore, Matteo Santamaria, Paolo Della Bella, Michele Manzo, Daniele Giacopelli, Alessio Gargaro, Antonio D'Onofrio

Research output: Contribution to journalArticle

Abstract

Introduction: Clinical trials did not provide conclusive evidence concerning the benefit of prophylactic implantable cardioverter-defibrillators (ICDs) in patients with severe nonischemic cardiomyopathy (NICM). We aimed to compare incidence of appropriate sustained ventricular arrhythmia (SVA) and device therapy in ischemic cardiomyopathy (ICM) vs NICM ICD and/or cardiac resynchronization therapy (CRT-D) patients. Methods and Results: We analyzed remote-monitoring data from devices of the Home Monitoring Expert Alliance network. SVA recordings were adjudicated by three independent electrophysiologists. Our cohort included 1,946 patients who received either an ICD (55%) or a CRT-D (45%) for primary prevention of sudden cardiac death. Median (interquartile range) age was 70 (62-77) years, 81% were male, and 52% were in the ICM group. Patients were remotely monitored for a maximum follow-up of 5 years. The 5-year product-limit estimate of SVA incidence in patients with an ICD was 47.3% (95% confidence interval [CI], 41.0%-53.9%) in the ICM group and 44.7% (36.9%-53.3%) in the NICM group. In patients with a CRT-D, SVA incidence was 45.7% (37.3%-55.0%) in ICM patients and 49.2% (40.4%-58.7%) in NICM patients. The adjusted hazard ratio for SVA in the ICM vs NICM group was 0.96 (95% CI: 0.70-1.30, P =.77) in ICD patients and 0.85 (95% CI: 0.61-1.18, P =.34) in CRT-D patients. SVAs triggered appropriate device therapies with similar incidence in all groups. Conclusion: In a large cohort of remotely monitored ICD and CRT-D recipients, SVA incidence did not significantly differ in ICM and NICM patients.

Original languageEnglish
Pages (from-to)1626-1635
Number of pages10
JournalJournal of Cardiovascular Electrophysiology
Volume30
Issue number9
DOIs
Publication statusPublished - Sep 1 2019

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Keywords

  • implantable cardioverter defibrillator
  • ischemic cardiomyopathy
  • nonischemic cardiomyopathy
  • remote-monitoring
  • ventricular arrhythmia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Forleo, G. B., Solimene, F., Pisanò, E. C., Zanotto, G., Calvi, V., Pignalberi, C., Maglia, G., Iacopino, S., Quartieri, F., Biffi, M., Caravati, F., Curnis, A., Capucci, A., Senatore, G., Santamaria, M., Della Bella, P., Manzo, M., Giacopelli, D., Gargaro, A., & D'Onofrio, A. (2019). Long-term outcomes after prophylactic ICD and CRT-D implantation in nonischemic patients: Analysis from a nationwide database of daily remote-monitoring transmissions. Journal of Cardiovascular Electrophysiology, 30(9), 1626-1635. https://doi.org/10.1111/jce.14006