Key result
Having ≥2 independent risk factors (EF<40%, permanent AF, QRS≥150 ms) was associated with a 100% 2-year risk of VT/VF occurrence in ICD patients, compared to 19.3% with no risk factors.
Why the study?
What are the independent predictors of VT/VF occurrence in patients with implantable cardioverter-defibrillators?
Cohort (n=250)
What are the independent predictors of VT/VF occurrence in patients with implantable cardioverter-defibrillators?
In ICD patients, the presence of two or more risk factors (EF<40%, permanent AF, QRS>=150 ms) identifies a subgroup with a 100% 2-year risk of VT/VF occurrence.
Answers are grounded in this paper and cite their sources.
Should not yet change ICD management; hypothesis-generating for VT/VF risk stratification in prospective studies.
AIMS: Identification of risk factors for ventricular tachycardia/ventricular fibrillation (VT/VF) occurrence in patients with implantable cardioverter-defibrillators (ICD) is reasonable, because ICD patients with multiple risk factors might benefit from more aggressive anti-arrhythmic therapy for the prevention of arrhythmic events. Furthermore, in the era of prophylactic ICD therapy and limited healthcare resources, additional markers are needed for improved patient selection. METHODS AND RESULTS: Thus, in Prospective Analysis of Risk Factor for Appropriate ICD Therapy (PROFIT), we prospectively analyzed the role of ejection fraction (EF), N-terminal probrain natriuretic peptide (NT-proBNP), New York Heart Association (NYHA) class, atrial fibrillation, and QRS-duration as independent predictors for VT/VF occurrence in 250 ICD patients. Kaplan-Meier analysis showed that EF<40% (log-rank P=0.001), NT-proBNP levels higher than median (>or=405 ng/L; log-rank P=0.04), QRS-duration >or=150 ms (log-rank P=0.016), permanent atrial fibrillation (log-rank P=0.008), and higher NYHA class (log-rank P=0.029) were associated with VT/VF occurrence. By multivariate Cox regression analysis EF, QRS-duration and atrial fibrillation remained significantly associated with appropriate VT/VF therapy, whereas there was no relationship among NT-proBNP, NYHA class, and VT/VF occurrence. Stratifying patients according to the number of their independent risk factors (EF<40%, AF, QRS-width>or=150 ms) showed that patients with greater than or equal to two risk factors had a 100% 2-year risk of VT/VF occurrence, whereas patients with no or one risk factor had a 19.3 and 25% 2-year risk, respectively. CONCLUSIONS: EF<40%, permanent atrial fibrillation, and QRS>or=150 ms are independent predictors for VT/VF occurrence in predominantly secondary prophylactic ICD patients. Combining all independent predictors, we developed a risk score for VT/VF occurrence identifying a subgroup of patients with two or more risk factors who had a 100% 2-year risk. Future studies will reveal if this risk score helps to identify ICD patients suitable for empirical anti-arrhythmic therapy and to improve patient selection for prophylactic ICD therapy.
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Klein et al. (2006) conducted a cohort in Implantable cardioverter-defibrillator (ICD) patients (n=250). Risk factors (EF<40%, permanent atrial fibrillation, QRS≥150 ms) vs. 0 or 1 risk factor was evaluated on VT/VF occurrence. Having ≥2 independent risk factors (EF<40%, permanent AF, QRS≥150 ms) was associated with a 100% 2-year risk of VT/VF occurrence in ICD patients, compared to 19.3% with no risk factors.
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