Key result
The incidence of sustained ventricular arrhythmia did not significantly differ between ischemic and nonischemic cardiomyopathy patients receiving an ICD (HR 0.96) or CRT-D (HR 0.85).
Why the study?
Clinical trials did not provide conclusive evidence concerning the benefit of prophylactic ICDs in patients with severe nonischemic cardiomyopathy.
Does the incidence of sustained ventricular arrhythmias and appropriate device therapies differ between nonischemic and ischemic cardiomyopathy patients receiving prophylactic ICD or CRT-D?
Cohort (n=1,946)
Yes
Does the incidence of sustained ventricular arrhythmias and appropriate device therapies differ between nonischemic and ischemic cardiomyopathy patients receiving prophylactic ICD or CRT-D?
Hazard Ratio: 0.96 (95% CI 0.7–1.3)
Absolute Event Rate: 47.3% vs 44.7%
p-value: p=0.77
Patients with nonischemic cardiomyopathy experience similar rates of sustained ventricular arrhythmias and appropriate device therapies compared to those with ischemic cardiomyopathy, supporting the continued use of primary prevention ICDs in the nonischemic population.
INTRODUCTION: Clinical trials did not provide conclusive evidence concerning the benefit of prophylactic implantable cardioverter-defibrillators (ICDs) in patients with severe nonischemic cardiomyopathy (NICM). We aimed to compare incidence of appropriate sustained ventricular arrhythmia (SVA) and device therapy in ischemic cardiomyopathy (ICM) vs NICM ICD and/or cardiac resynchronization therapy (CRT-D) patients. METHODS AND RESULTS: We analyzed remote-monitoring data from devices of the Home Monitoring Expert Alliance network. SVA recordings were adjudicated by three independent electrophysiologists. Our cohort included 1,946 patients who received either an ICD (55%) or a CRT-D (45%) for primary prevention of sudden cardiac death. Median (interquartile range) age was 70 (62-77) years, 81% were male, and 52% were in the ICM group. Patients were remotely monitored for a maximum follow-up of 5 years. The 5-year product-limit estimate of SVA incidence in patients with an ICD was 47.3% (95% confidence interval [CI], 41.0%-53.9%) in the ICM group and 44.7% (36.9%-53.3%) in the NICM group. In patients with a CRT-D, SVA incidence was 45.7% (37.3%-55.0%) in ICM patients and 49.2% (40.4%-58.7%) in NICM patients. The adjusted hazard ratio for SVA in the ICM vs NICM group was 0.96 (95% CI: 0.70-1.30, P = .77) in ICD patients and 0.85 (95% CI: 0.61-1.18, P = .34) in CRT-D patients. SVAs triggered appropriate device therapies with similar incidence in all groups. CONCLUSION: In a large cohort of remotely monitored ICD and CRT-D recipients, SVA incidence did not significantly differ in ICM and NICM patients.
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Forleo et al. (2019) conducted a cohort in Ischemic and nonischemic cardiomyopathy (n=1,946). Ischemic cardiomyopathy (ICM) vs. Nonischemic cardiomyopathy (NICM) was evaluated on Sustained ventricular arrhythmia (SVA) in ICD patients (HR 0.96, 95% CI 0.70-1.30, p=0.77). The incidence of sustained ventricular arrhythmia did not significantly differ between ischemic and nonischemic cardiomyopathy patients receiving an ICD (HR 0.96) or CRT-D (HR 0.85).
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