Key result
A history of atrial fibrillation before ICD implantation independently increased the risk of electrical storm (HR 2.3) in patients with idiopathic dilated cardiomyopathy.
Why the study?
What are the predictors of electrical storm in patients with idiopathic dilated cardiomyopathy and an ICD?
Cohort (n=53)
No
What are the predictors of electrical storm in patients with idiopathic dilated cardiomyopathy and an ICD?
Hazard Ratio: 2.3 (95% CI 1.2–5)
p-value: p=0.013
In patients with idiopathic dilated cardiomyopathy and an ICD, signal-averaged ECG parameters (longer LAS40, lower RMS40) and a history of atrial fibrillation are strong independent predictors of electrical storm.
Supports AF history for risk stratification in idiopathic dilated cardiomyopathy ICD patients; leaves open prospective validation of preventive strategies.
BACKGROUND: Electrical storm (ES) is a serious problem in patients with an implantable cardioverter defibrillator (ICD). However, insufficient reports have indicated the predictors of ES in ICD patients with idiopathic dilated cardiomyopathy (DCM). The purpose of this study was to clarify the predictors of ES for risk stratification in DCM patients with an ICD. METHODS AND RESULTS: Of 446 ICD patients, 53 DCM patients were included in this study. During a mean follow-up of 55+/-36 months, ES (> or =3 times appropriate ICD therapy within 24 h) occurred in 18/53 (34%) patients. According to multivariate Cox proportional hazard regression analysis, a duration of the terminal low amplitude signals of <40 microV (LAS40) (HR 1.4/10 ms increase, 95% confidence interval (CI) 1.1-2.1; P=0.0049) or root mean square voltage of the last 40 ms of the QRS complex (RMS40) (HR 0.88/1 microV, 95%CI 0.77-0.96; P=0.001) on the signal averaged electrocardiogram, and a history of atrial fibrillation (AF) before ICD implantation (HR 2.3, 95%CI 1.2-5.0; P=0.013) were independently associated with an increased risk of ES. CONCLUSIONS: Our data indicated that a longer LAS40, lower RMS40 and history of AF before ICD implantation could strongly predict ES, and the combination of those parameters could effectively stratify the risk of ES in DCM patients.
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Takigawa et al. (2010) conducted a cohort in Idiopathic Dilated Cardiomyopathy (DCM) with an ICD (n=53). History of atrial fibrillation before ICD implantation vs. No history of atrial fibrillation was evaluated on Occurrence of electrical storm (≥3 times appropriate ICD therapy within 24 h) (HR 2.3, 95% CI 1.2-5.0, p=0.013). A history of atrial fibrillation before ICD implantation independently increased the risk of electrical storm (HR 2.3) in patients with idiopathic dilated cardiomyopathy.
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