PMID- 16864615
OWN - NLM
STAT- MEDLINE
DCOM- 20061205
LR  - 20220318
IS  - 1099-5129 (Print)
IS  - 1099-5129 (Linking)
VI  - 8
IP  - 8
DP  - 2006 Aug
TI  - Predictors of VT/VF-occurrence in ICD patients: results from the PROFIT-Study.
PG  - 618-24
AB  - 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.
FAU - Klein, Gunnar
AU  - Klein G
AD  - Department of Cardiovascular Medicine, Hannover Medical School, 
      Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. gunnarklein@yahoo.de
FAU - Lissel, Christoph
AU  - Lissel C
FAU - Fuchs, Anne-Catherine
AU  - Fuchs AC
FAU - Gardiwal, Ajmal
AU  - Gardiwal A
FAU - Oswald, Hanno
AU  - Oswald H
FAU - Desousa, Marcos
AU  - Desousa M
FAU - Pichlmaier, A Maximilian
AU  - Pichlmaier AM
FAU - Lichtinghagen, Ralf
AU  - Lichtinghagen R
FAU - Geerlings, Heinz
AU  - Geerlings H
FAU - Lippolt, Peter
AU  - Lippolt P
FAU - Niehaus, Michael
AU  - Niehaus M
FAU - Drexler, Helmut
AU  - Drexler H
FAU - Korte, Thomas
AU  - Korte T
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PL  - England
TA  - Europace
JT  - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal 
      of the working groups on cardiac pacing, arrhythmias, and cardiac cellular 
      electrophysiology of the European Society of Cardiology
JID - 100883649
RN  - 0 (Anti-Arrhythmia Agents)
RN  - 0 (Peptide Fragments)
RN  - 0 (pro-brain natriuretic peptide (1-76))
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
SB  - IM
MH  - Aged
MH  - Anti-Arrhythmia Agents/*therapeutic use
MH  - Atrial Fibrillation/physiopathology
MH  - Cohort Studies
MH  - *Defibrillators, Implantable
MH  - Electrocardiography
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Natriuretic Peptide, Brain/physiology
MH  - Patient Selection
MH  - Peptide Fragments/physiology
MH  - Predictive Value of Tests
MH  - Prospective Studies
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Stroke Volume/physiology
MH  - Tachycardia, Ventricular/classification/*etiology/*physiopathology/prevention & 
      control
MH  - Ventricular Fibrillation/classification/*etiology/*physiopathology/prevention & 
      control
EDAT- 2006/07/26 09:00
MHDA- 2006/12/09 09:00
CRDT- 2006/07/26 09:00
PHST- 2006/07/26 09:00 [pubmed]
PHST- 2006/12/09 09:00 [medline]
PHST- 2006/07/26 09:00 [entrez]
AID - 8/8/618 [pii]
AID - 10.1093/europace/eul082 [doi]
PST - ppublish
SO  - Europace. 2006 Aug;8(8):618-24. doi: 10.1093/europace/eul082.