P-wave and interatrial block: New predictor for atrial high rate episodes in patients with cardiac implantable electronic devices.

BACKGROUND: The presence of interatrial block (IAB) is associated with the development of atrial fibrillation (AF). The aim of this study was to determine whether P-wave duration and presence of IAB before the implantation of a cardiac implantable electronic device (CIED) are associated with the presence of atrial high rate episodes (AHRE), during long-term follow-up. METHODS: 380 patients (57% men; 75 ± 10 years) were included. IAB was defined according to the International Consensus Criteria. AHRE was defined as an episode of atrial rate ≥225 beats/min with a minimum duration of 5 minutes. RESULTS: Documented paroxysmal AF before the implantation was present in 24% of the patients; 80% had hypertension and 32% structural heart disease. Mean P-wave duration was 123 ± 23 ms, and 39% of the patients had IAB (32% partial, 7% advanced). After a mean follow-up of 18 ± 12 months, 33% of the patients presented AHRE. Patients with AHRE had a P-wave duration significantly longer (130 ± 24 ms vs 119 ± 21 ms; P < 0.001) and a greater prevalence of IAB (53% vs 32%; P < 0.001). In a multivariate analysis, predictors of AHRE were: IAB (odds ratio [OR] 2.1; 95% confidence interval [CI] [1.3-3.4], P < 0.001) and previous paroxysmal AF (OR 2.6; 95% CI [1.5-4.3], P < 0.001). In patients without previous AF, the presence of IAB was also a significant predictor of AHRE (OR 3.1; 95% CI [1.8-5.5], P < 0.001). CONCLUSIONS: IAB is a strong predictor of AHRE in patients with CIED. This finding is independent of the presence of prior paroxysmal AF.

Prevención primaria de muerte súbita en pacientes con miocardiopatía valvular / Primary prevention of sudden death in patients with valvular cardiomyopathy

Introducción y objetivos: Existe escasa evidencia sobre la evolución de los pacientes con miocardiopatía valvular remitidos para implante de desfibrilador por prevención primaria. Se pretende describir la evolución de este subgrupo particular. Métodos: Estudio multicéntrico retrospectivo en 15 centros españoles que incluyó pacientes consecutivos remitidos para implante de desfibrilador en los años 2010 y 2011, y en tres centros desde el 1 enero de 2008. Resultados: De un total de 1.174 pacientes, 73 (6,2%) presentaron miocardiopatía valvular. Comparados con los pacientes con miocardiopatía isquémica (n = 659; 56,1%) o dilatada (n = 442; 37,6%), presentaron peor clase funcional, mayor anchura del QRS y antecedente de fibrilación auricular. Durante un seguimiento de 38,1 ± 21,3 meses, 197 (16,7%) pacientes fallecieron por cualquier causa, sin diferencias significativas entre grupos (19,2% en miocardiopatía valvular, 15,8% en isquémica y 17,9% en miocardiopatía dilatada; p = 0,2). De estos, 136 murieron por causa cardiovascular (11,6%), sin diferencias significativas (12,3%; 10,5% y 13,1%, respectivamente; p = 0,1). Tampoco hubo diferencias en la proporción de intervenciones apropiadas del desfibrilador (13,7%; 17,9% y 18,8%; p = 0,4), pero sí en el de inapropiadas (8,2%; 7,1% y 12,0%, respectivamente; p = 0,03). Conclusiones: Las tasas de mortalidad por cualquier causa y por causa cardiovascular en pacientes con miocardiopatía valvular fueron similares a las del resto de los pacientes remitidos para implante de desfibrilador. También presentaron similares tasas de intervenciones apropiadas. Estos datos parecen indicar que el implante de un desfibrilador en este grupo confiere un beneficio similar al que obtienen los pacientes con miocardiopatía isquémica y miocardiopatía dilatada (AU)

Introduction and objectives: Few data exist on the outcomes of valvular cardiomyopathy patients referred for defibrillator implantation for primary prevention. The aim of the present study was to describe the outcomes of this cardiomyopathy subgroup. Methods: This multicenter retrospective study included consecutive patients referred for defibrillator implantation to 15 Spanish centers in 2010 and 2011, and to 3 centers after 1 January 2008. Results: Of 1174 patients, 73 (6.2%) had valvular cardiomyopathy. These patients had worse functional class, wider QRS, and a history of atrial fibrillation vs patients with ischemic (n = 659; 56.1%) or dilated (n = 442; 37.6%) cardiomyopathy. During a follow-up of 38.1 ± 21.3 months, 197 patients (16.7%) died, without significant differences among the groups (19.2% in the valvular cardiomyopathy group, 15.8% in the ischemic cardiomyopathy group, and 17.9% in the dilated cardiomyopathy group; P = .2); 136 died of cardiovascular causes (11.6%), without significant differences among the groups (12.3%, 10.5%, and 13.1%, respectively; P = .1). Although there were no differences in the proportion of appropriate defibrillator interventions (13.7%, 17.9%, and 18.8%; P = .4), there was a difference in inappropriate interventions (8.2%, 7.1%, and 12.0%, respectively; P = .03). Conclusions: All-cause and cardiovascular mortality in patients with valvular cardiomyopathy were similar to those in other patients referred for defibrillator implantation. They also had similar rates of appropriate interventions. These data suggest that defibrillator implantation in this patient group confers a similar benefit to that obtained by patients with ischemic or dilated cardiomyopathy (AU)

Primary Prevention of Sudden Death in Patients With Valvular Cardiomyopathy.

INTRODUCTION AND OBJECTIVES: Few data exist on the outcomes of valvular cardiomyopathy patients referred for defibrillator implantation for primary prevention. The aim of the present study was to describe the outcomes of this cardiomyopathy subgroup. METHODS: This multicenter retrospective study included consecutive patients referred for defibrillator implantation to 15 Spanish centers in 2010 and 2011, and to 3 centers after 1 January 2008. RESULTS: Of 1174 patients, 73 (6.2%) had valvular cardiomyopathy. These patients had worse functional class, wider QRS, and a history of atrial fibrillation vs patients with ischemic (n=659; 56.1%) or dilated (n=442; 37.6%) cardiomyopathy. During a follow-up of 38.1 ± 21.3 months, 197 patients (16.7%) died, without significant differences among the groups (19.2% in the valvular cardiomyopathy group, 15.8% in the ischemic cardiomyopathy group, and 17.9% in the dilated cardiomyopathy group; P=.2); 136 died of cardiovascular causes (11.6%), without significant differences among the groups (12.3%, 10.5%, and 13.1%, respectively; P=.1). Although there were no differences in the proportion of appropriate defibrillator interventions (13.7%, 17.9%, and 18.8%; P=.4), there was a difference in inappropriate interventions (8.2%, 7.1%, and 12.0%, respectively; P=.03). CONCLUSIONS: All-cause and cardiovascular mortality in patients with valvular cardiomyopathy were similar to those in other patients referred for defibrillator implantation. They also had similar rates of appropriate interventions. These data suggest that defibrillator implantation in this patient group confers a similar benefit to that obtained by patients with ischemic or dilated cardiomyopathy.

[Electrical storm in patients with prophylactic defibrillator implantation]. / Evolución de los pacientes portadores de desfibrilador como prevención primaria tras un episodio de tormenta arrítmica.

INTRODUCTION: Little is known about the prevalence of electrical storm, baseline characteristics and mortality implications of patients with implantable cardioverter defibrillator in primary prevention versus those patients without electrical storm. We sought to assess the prevalence, baseline risk profile and survival significance of electrical storm in patients with implantable defibrillator for primary prevention. METHODS: Retrospective multicenter study performed in 15 Spanish hospitals. Consecutives patients referred for desfibrillator implantation, with or without left ventricular lead (at least those performed in 2010 and 2011), were included. RESULTS: Over all 1,174 patients, 34 (2,9%) presented an electrical storm, mainly due to ventricular tachycardia (82.4%). There were no significant baseline differences between groups, with similar punctuation in the mortality risk scores (SHOCKED, MADIT and FADES). A clear trigger was identified in 47% of the events. During the study period (38±21 months), long-term total mortality (58.8% versus 14.4%, p<0.001) and cardiac mortality (52.9% versus 8.6%, p<0.001) were both increased among electrical storm patients. Rate of inappropriate desfibrillator intervention was also higher (14.7 versus 8.6%, p<0.001). CONCLUSIONS: In the present study of patients with desfibrillator implantation for primary prevention, prevalence of electrical storm was 2.9%. There were no baseline differences in the cardiovascular risk profile versus those without electrical storm. However, all cause mortality and cardiovascular mortality was increased in these patients versus control desfibrillator patients without electrical storm, as was the rate of inappropriate desfibrillator intervention.