Implantable cardioverter defibrillators in patients with electrical heart disease and hypertrophic cardiomyopathy: data from the German device registry.
Adult
Aged
Arrhythmias, Cardiac
/ diagnosis
Cardiomyopathy, Hypertrophic
/ diagnosis
Case-Control Studies
Comorbidity
Databases, Factual
Death, Sudden, Cardiac
/ epidemiology
Defibrillators, Implantable
Electric Countershock
/ adverse effects
Female
Germany
/ epidemiology
Humans
Male
Middle Aged
Primary Prevention
Registries
Risk Assessment
Risk Factors
Secondary Prevention
Time Factors
Treatment Outcome
Electrical heart disease
Hypertrophic cardiomyopathy
ICD implantation
Sudden cardiac death
Journal
Clinical research in cardiology : official journal of the German Cardiac Society
ISSN: 1861-0692
Titre abrégé: Clin Res Cardiol
Pays: Germany
ID NLM: 101264123
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
20
04
2019
accepted:
18
07
2019
pubmed:
2
8
2019
medline:
29
12
2020
entrez:
2
8
2019
Statut:
ppublish
Résumé
Implantable cardioverter- defibrillator (ICD) therapy is established for the prevention of sudden cardiac death (SCD) in different entities. However, data from large patient cohorts with electrical heart disease are rare. Therefore, we investigated these patients as well as patients with hypertrophic cardiomyopathy by analyzing registry data from a multi-center 'real-life' registry. The German Device Registry (DEVICE) is a nationwide, prospective registry with one-year follow-up investigating 5450 patients receiving device implantations in 50 German centers. The present analysis of DEVICE focussed on patients with electrical heart disease or HCM who received an ICD for primary or secondary prevention. 174 patients with HCM and 112 patients with electrical heart disease (long-QT syndrome, Brugada syndrome and arrhythmogenic right ventricular cardiomyopathy) were compared with 5164 other ICD patients. Median follow-up was 17.0 months. Patients in the control group were significantly older. Of note, overall mortality after 1 year was 1.8% in HCM patients, 6.6% in patients with electrical heart disease and 7.3% in the control group. Patients in the control group presented significantly more severe comorbidities. In contrast to HCM patients and the control group where primary prevention was the major indication for ICD implantation, 77.5% of patients with electrical heart disease received an ICD for secondary prevention. The number of surgical revisions was higher in patients with electrical heart disease. Data from the present registry display a surprisingly high mortality in patients with electrical heart disease equivalent to the control group. A high proportion of patients who received an ICD for secondary prevention may be regarded as a major determinant for these results, while severe comorbidities such as diabetes, hypertension, and renal failure are major determinants for mortality in the control cohort.
Sections du résumé
BACKGROUND
BACKGROUND
Implantable cardioverter- defibrillator (ICD) therapy is established for the prevention of sudden cardiac death (SCD) in different entities. However, data from large patient cohorts with electrical heart disease are rare. Therefore, we investigated these patients as well as patients with hypertrophic cardiomyopathy by analyzing registry data from a multi-center 'real-life' registry.
METHODS
METHODS
The German Device Registry (DEVICE) is a nationwide, prospective registry with one-year follow-up investigating 5450 patients receiving device implantations in 50 German centers. The present analysis of DEVICE focussed on patients with electrical heart disease or HCM who received an ICD for primary or secondary prevention.
RESULTS
RESULTS
174 patients with HCM and 112 patients with electrical heart disease (long-QT syndrome, Brugada syndrome and arrhythmogenic right ventricular cardiomyopathy) were compared with 5164 other ICD patients. Median follow-up was 17.0 months. Patients in the control group were significantly older. Of note, overall mortality after 1 year was 1.8% in HCM patients, 6.6% in patients with electrical heart disease and 7.3% in the control group. Patients in the control group presented significantly more severe comorbidities. In contrast to HCM patients and the control group where primary prevention was the major indication for ICD implantation, 77.5% of patients with electrical heart disease received an ICD for secondary prevention. The number of surgical revisions was higher in patients with electrical heart disease.
CONCLUSION
CONCLUSIONS
Data from the present registry display a surprisingly high mortality in patients with electrical heart disease equivalent to the control group. A high proportion of patients who received an ICD for secondary prevention may be regarded as a major determinant for these results, while severe comorbidities such as diabetes, hypertension, and renal failure are major determinants for mortality in the control cohort.
Identifiants
pubmed: 31367999
doi: 10.1007/s00392-019-01532-9
pii: 10.1007/s00392-019-01532-9
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
508-512Références
Priori SG, Blomstrom-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J et al (2015) 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: the task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European society of cardiology (ESC) endorsed by: association for european paediatric and congenital cardiology (AEPC). Europace. 17:1601–1687
pubmed: 26318695
Moss AJ, Hall WJ, Cannom DS, Daubert JP, Higgins SL, Klein H et al (1996) Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia Multicenter automatic defibrillator implantation trial investigators. N Engl J Med. 335:1933–1940
doi: 10.1056/NEJM199612263352601
Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Cannom DS et al (2002) Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 346:877–883
doi: 10.1056/NEJMoa013474
Bardy GH, Lee KL, Mark DB, Poole JE, Packer DL, Boineau R et al (2005) Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure. N Engl J Med. 352:225–237
doi: 10.1056/NEJMoa043399
Kadish A, Dyer A, Daubert JP, Quigg R, Estes NA, Anderson KP et al (2004) Prophylactic defibrillator implantation in patients with nonischemic dilated cardiomyopathy. N Engl J Med. 350:2151–2158
doi: 10.1056/NEJMoa033088
Kobe J, Andresen D, Maier S, Stellbrink C, Kleemann T, Gonska BD et al (2017) Complications and 1-year benefit of cardiac resynchronization therapy in patients over 75 years of age—Insights from the German device registry. Int J Cardiol 228:784–789
doi: 10.1016/j.ijcard.2016.11.212
D'Ancona G, Safak E, Senges J, Hochadel M, Nguyen VL, Perings C et al (2017) Activation of remote monitoring for cardiac implantable electronic devices: small dog for tall weeds. Clin Res Cardiol 106:833–839
doi: 10.1007/s00392-017-1127-9
Frommeyer G, Andresen D, Ince H, Maier S, Stellbrink C, Kleemann T et al (2019) Can we rely on Danish? real-world data on patients with nonischemic cardiomyopathy from the German device registry. Heart Vessels 34(7):1196–1202
doi: 10.1007/s00380-018-01337-2
Frommeyer G, Dechering DG, Zumhagen S, Loher A, Kobe J, Eckardt L et al (2016) Long-term follow-up of subcutaneous ICD systems in patients with hypertrophic cardiomyopathy: a single-center experience. Clin Res Cardiol 105:89–93
doi: 10.1007/s00392-015-0901-9
Vamos M, Healey JS, Wang J, Connolly SJ, Mabo P, Van Erven L et al (2018) Implantable cardioverter-defibrillator therapy in hypertrophic cardiomyopathy: a simple substudy. Heart rhythm. 15:386–392
doi: 10.1016/j.hrthm.2017.11.020
Frommeyer G, Dechering DG, Kochhauser S, Bettin M, Kobe J, Eckardt L et al (2016) Long-time "real-life" performance of the subcutaneous ICD in patients with electrical heart disease or idiopathic ventricular fibrillation. J Interventional Cardiac Electrophysiol. 47:185–188
doi: 10.1007/s10840-016-0143-4
Probst V, Veltmann C, Eckardt L, Meregalli PG, Gaita F, Tan HL et al (2010) Long-term prognosis of patients diagnosed with Brugada syndrome: results from the Finger Brugada syndrome registry. Circulation 121:635–643
doi: 10.1161/CIRCULATIONAHA.109.887026
Monnig G, Kobe J, Loher A, Wasmer K, Milberg P, Zellerhoff S et al (2012) Role of implantable cardioverter defibrillator therapy in patients with acquired long QT syndrome: a long-term follow-up. Europace 14:396–401
doi: 10.1093/europace/eur316
Schuler PK, Haegeli LM, Saguner AM, Wolber T, Tanner FC, Jenni R et al (2012) Predictors of appropriate ICD therapy in patients with arrhythmogenic right ventricular cardiomyopathy: long term experience of a tertiary care center. PLoS ONE 7:e39584
doi: 10.1371/journal.pone.0039584
Frommeyer G, Feder S, Bettin M, Debus V, Kobe J, Reinke F et al (2018) Long-term single-center experience of defibrillator therapy in children and adolescents. Int J Cardiol 271:105–108
doi: 10.1016/j.ijcard.2018.05.130
Willy K, Bettin M, Reinke F, Bogeholz N, Ellermann C, Rath B et al (2019) Feasibility of entirely subcutaneous ICD systems in patients with coronary artery disease. Clin Res Cardiol. https://doi.org/10.1007/s00392-019-01455-5
doi: 10.1007/s00392-019-01455-5
pubmed: 31667624