Who are the long-QT syndrome patients who receive an implantable cardioverter-defibrillator and what happens to them?

Data from the European Long-QT syndrome implantable cardioverter-defibrillator (LQTS ICD) registry

Peter J. Schwartz, Carla Spazzolini, Silvia G. Priori, Lia Crotti, Alessandro Vicentini, Maurizio Landolina, Maurizio Gasparini, Arthur A M Wilde, Reinoud E. Knops, Isabelle Denjoy, Lauri Toivonen, Gerold Mönnig, Majid Al-Fayyadh, Luc Jordaens, Martin Borggrefe, Christina Holmgren, Pedro Brugada, Luc De Roy, Stefan H. Hohnloser, Paul A. Brink

Research output: Contribution to journalArticle

176 Citations (Scopus)

Abstract

Background-: A rapidly growing number of long-QT syndrome (LQTS) patients are being treated with an implantable cardioverter-defibrillator (ICD). ICDs may pose problems, especially in the young. We sought to determine the characteristics of the LQTS patients receiving an ICD, the indications, and the aftermath. Methods And Results-: The study population included 233 patients. Beginning in 2002, data were collected prospectively. Female patients (77%) and LQT3 patients (22% of genotype positive) were overrepresented; mean QTc was 516±65 milliseconds; mean age at implantation was 30±17 years; and genotype was known in 59% of patients. Unexpectedly, 9% of patients were asymptomatic before implantation. Asymptomatic patients, almost absent among LQT1 and LQT2 patients, represented 45% of LQT3 patients. Patients with cardiac symptoms made up 91% of all study participants, but only 44% had cardiac arrest before ICD implantation. In addition, 41% of patients received an ICD without having first been on LQTS therapy. During follow-up, 4.6±3.2 years, at least 1 appropriate shock was received by 28% of patients, and adverse events occurred in 25%. Appropriate ICD therapies were predicted by age 500 milliseconds, prior cardiac arrest, and cardiac events despite therapy; within 7 years, appropriate shocks occurred in no patients with none of these factors and in 70% of those with all factors. Conclusions-: Reflecting previous concepts, ICDs were implanted in some LQTS patients whose high risk now appears questionable. Refined criteria for implantation, reassessment of pros and cons, ICD reprogramming, and consideration for other existing therapeutic options are necessary.

Original languageEnglish
Pages (from-to)1272-1282
Number of pages11
JournalCirculation
Volume122
Issue number13
DOIs
Publication statusPublished - Sep 28 2010

Fingerprint

Long QT Syndrome
Implantable Defibrillators
Registries
Heart Arrest
Shock
Genotype
Therapeutics

Keywords

  • arrhythmia
  • defibrillation
  • genetics
  • heart arrest
  • long QT syndrome

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Cite this

Who are the long-QT syndrome patients who receive an implantable cardioverter-defibrillator and what happens to them? Data from the European Long-QT syndrome implantable cardioverter-defibrillator (LQTS ICD) registry. / Schwartz, Peter J.; Spazzolini, Carla; Priori, Silvia G.; Crotti, Lia; Vicentini, Alessandro; Landolina, Maurizio; Gasparini, Maurizio; Wilde, Arthur A M; Knops, Reinoud E.; Denjoy, Isabelle; Toivonen, Lauri; Mönnig, Gerold; Al-Fayyadh, Majid; Jordaens, Luc; Borggrefe, Martin; Holmgren, Christina; Brugada, Pedro; De Roy, Luc; Hohnloser, Stefan H.; Brink, Paul A.

In: Circulation, Vol. 122, No. 13, 28.09.2010, p. 1272-1282.

Research output: Contribution to journalArticle

Schwartz, Peter J. ; Spazzolini, Carla ; Priori, Silvia G. ; Crotti, Lia ; Vicentini, Alessandro ; Landolina, Maurizio ; Gasparini, Maurizio ; Wilde, Arthur A M ; Knops, Reinoud E. ; Denjoy, Isabelle ; Toivonen, Lauri ; Mönnig, Gerold ; Al-Fayyadh, Majid ; Jordaens, Luc ; Borggrefe, Martin ; Holmgren, Christina ; Brugada, Pedro ; De Roy, Luc ; Hohnloser, Stefan H. ; Brink, Paul A. / Who are the long-QT syndrome patients who receive an implantable cardioverter-defibrillator and what happens to them? Data from the European Long-QT syndrome implantable cardioverter-defibrillator (LQTS ICD) registry. In: Circulation. 2010 ; Vol. 122, No. 13. pp. 1272-1282.
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abstract = "Background-: A rapidly growing number of long-QT syndrome (LQTS) patients are being treated with an implantable cardioverter-defibrillator (ICD). ICDs may pose problems, especially in the young. We sought to determine the characteristics of the LQTS patients receiving an ICD, the indications, and the aftermath. Methods And Results-: The study population included 233 patients. Beginning in 2002, data were collected prospectively. Female patients (77{\%}) and LQT3 patients (22{\%} of genotype positive) were overrepresented; mean QTc was 516±65 milliseconds; mean age at implantation was 30±17 years; and genotype was known in 59{\%} of patients. Unexpectedly, 9{\%} of patients were asymptomatic before implantation. Asymptomatic patients, almost absent among LQT1 and LQT2 patients, represented 45{\%} of LQT3 patients. Patients with cardiac symptoms made up 91{\%} of all study participants, but only 44{\%} had cardiac arrest before ICD implantation. In addition, 41{\%} of patients received an ICD without having first been on LQTS therapy. During follow-up, 4.6±3.2 years, at least 1 appropriate shock was received by 28{\%} of patients, and adverse events occurred in 25{\%}. Appropriate ICD therapies were predicted by age 500 milliseconds, prior cardiac arrest, and cardiac events despite therapy; within 7 years, appropriate shocks occurred in no patients with none of these factors and in 70{\%} of those with all factors. Conclusions-: Reflecting previous concepts, ICDs were implanted in some LQTS patients whose high risk now appears questionable. Refined criteria for implantation, reassessment of pros and cons, ICD reprogramming, and consideration for other existing therapeutic options are necessary.",
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AU - Spazzolini, Carla

AU - Priori, Silvia G.

AU - Crotti, Lia

AU - Vicentini, Alessandro

AU - Landolina, Maurizio

AU - Gasparini, Maurizio

AU - Wilde, Arthur A M

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AU - Hohnloser, Stefan H.

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