Key result
Ventricular tachyarrhythmias after surgical valve replacement linked to ~67% higher CV death risk.
Why the study?
The clinical significance and outcomes of ventricular tachyarrhythmias in patients undergoing valve replacement have rarely been reported.
Does the occurrence of ventricular tachyarrhythmias after surgical valve replacement worsen outcomes, and does ICD implantation improve survival in these patients?
Cohort (n=10,212)
Yes
Does the occurrence of ventricular tachyarrhythmias after surgical valve replacement worsen outcomes, and does ICD implantation improve survival in these patients?
Effect estimate: HR 1.67 (95% CI 1.41-1.96)
Absolute Event Rate: 80.5% vs 46.7%
p-value: p=<0.001
Ventricular tachyarrhythmias after surgical valve replacement are associated with increased risks of cardiovascular death and hospitalization, but ICD implantation significantly reduces mortality in these patients.
VTa after valve replacement was associated with higher CV death; leaves open whether ICDs improve survival, needing prospective trials.
Background: The clinical significance and outcomes of ventricular tachyarrhythmias (VTa) in patients undergoing valve replacement have rarely been reported. Objective: This study aimed to investigate the incidence and outcome of VTa after surgical valve replacement. Methods: We conducted a population-based retrospective cohort study using data obtained from the Taiwan National Health Insurance Research Database. In total, 10,212 patients were selected after 1:1 propensity-score matching based on the type of prosthetic valve used (mechanical vs. bioprosthetic). Various outcomes during long-term follow-up were analyzed. Results: After a median follow-up period of 59.6 months, the crude incidence rate of VTa after surgical valve replacement was 4.8/1,000 person-years, and the cumulative incidence of VTa persistently increased after surgery. Furthermore, the occurrences of VTa after valve replacement significantly increased the risk of cardiovascular (CV) death ( P < 0.001, HR 1.67, 95% CI 1.41–1.96), stroke- ( P < 0.001, HR 1.66, 95% CI 1.37–2.01), atrial fibrillation- ( P < 0.001, HR 2.80, 95% CI 2.42–3.24), and congestive heart failure-related hospitalization ( P < 0.001, HR 2.61, 95% CI 2.30–2.95). Among patients with VTa, all-cause mortality ( P = 0.001, HR 0.49, 95% CI 0.32–0.75) and CV death ( P = 0.047, HR 0.58, 95% CI 0.34–0.99) in those with implantable cardioverter-defibrillator (ICD) implantation were lower than those without. Conclusion: The crude incidence rate of VTa after surgical valve replacement was 4.8/1,000 person-years, and the cumulative incidence of VTa persistently increased during follow-up. The presence of VTa after surgical valve replacement increases hospitalization and CV death, while ICD implantation reduced the mortality rate in these patients.
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Li et al. (2021) conducted a cohort in Valvular heart disease requiring surgical valve replacement (n=10,212). Ventricular tachyarrhythmias (VTa) vs. No ventricular tachyarrhythmias was evaluated on Cardiovascular death (HR 1.67, 95% CI 1.41-1.96, p=<0.001). Ventricular tachyarrhythmias after surgical valve replacement significantly increased the risk of cardiovascular death (HR 1.67) compared to patients without VTa.
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