Key result
ICDs fail to improve survival and are linked to complications in CPVT after sudden cardiac arrest.
Why the study?
In patients with CPVT, ICD shocks are sometimes ineffective and can trigger fatal electrical storms, leaving the efficacy and complications of ICDs uncertain in patients presenting with SCA while undiagnosed.
Does implantable cardioverter-defibrillator (ICD) implantation reduce sudden cardiac death in previously undiagnosed patients with CPVT resuscitated from sudden cardiac arrest?
Does implantable cardioverter-defibrillator (ICD) implantation reduce sudden cardiac death in previously undiagnosed patients with CPVT resuscitated from sudden cardiac arrest?
In CPVT patients presenting with sudden cardiac arrest, ICD implantation did not improve survival compared to guideline-directed medical therapy alone and was associated with significant device-related morbidity.
ICD implantation was not associated with survival benefit yet increased complications in CPVT arrest survivors; leaves open optimal device use versus medical therapy alone.
Aims In patients with catecholaminergic polymorphic ventricular tachycardia (CPVT), implantable cardioverter-defibrillator (ICD) shocks are sometimes ineffective and may even trigger fatal electrical storms. We assessed the efficacy and complications of ICDs placed in patients with CPVT who presented with a sentinel event of sudden cardiac arrest (SCA) while undiagnosed and therefore untreated. Methods and results We analysed 136 patients who presented with SCA and in whom CPVT was diagnosed subsequently, leading to the initiation of guideline-directed therapy, including β-blockers, flecainide, and/or left cardiac sympathetic denervation. An ICD was implanted in 79 patients (58.1%). The primary outcome of the study was sudden cardiac death (SCD). The secondary outcomes were composite outcomes of SCD, SCA, appropriate ICD shocks, and syncope. After a median follow-up of 4.8 years, SCD had occurred in three patients (3.8%) with an ICD and none of the patients without an ICD (P = 0.1). SCD, SCA, or appropriate ICD shocks occurred in 37 patients (46.8%) with an ICD and 9 patients (15.8%) without an ICD (P < 0.0001). Inappropriate ICD shocks occurred in 19 patients (24.7%) and other device-related complications in 22 patients (28.9%). Conclusion In previously undiagnosed patients with CPVT who presented with SCA, an ICD was not associated with improved survival. Instead, the ICD was associated with both a high rate of appropriate ICD shocks and inappropriate ICD shocks along with other device-related complications. Strict adherence to guideline-directed therapy without an ICD may provide adequate protection in these patients without all the potential disadvantages of an ICD.
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Werf et al. (2019) studied this question. In patients with catecholaminergic polymorphic ventricular tachycardia who suffered sudden cardiac arrest, an ICD did not improve survival and led to many complications.
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