PMID- 24196450
OWN - NLM
STAT- MEDLINE
DCOM- 20150219
LR  - 20140626
IS  - 1532-2092 (Electronic)
IS  - 1099-5129 (Linking)
VI  - 16
IP  - 7
DP  - 2014 Jul
TI  - Heart rate turbulence predicts ICD-resistant mortality in ischaemic heart 
      disease.
PG  - 1069-77
LID - 10.1093/europace/eut303 [doi]
AB  - AIMS: In high-risk patients, implantable cardioverter-defibrillators (ICDs) can 
      convert the mode of death from arrhythmic to pump failure death. Therefore, we 
      introduced the concept of 'ICD-resistant mortality' (IRM), defined as death (a) 
      without previous appropriate ICD intervention (AI), (b) within 1 month after the 
      first AI, or (c) within 1 year after the initial ICD implantation. Implantable 
      cardioverter-defibrillator implantation in patients with a high risk of IRM 
      should be avoided. METHODS AND RESULTS: Implantable cardioverter-defibrillator 
      patients with ischaemic heart disease were included if a digitized 24 h Holter 
      was available pre-implantation. Demographic, electrocardiographic, 
      echocardiographic, and 24 h Holter risk factors were collected at device 
      implantation. The primary endpoint was IRM. Cox regression analyses were used to 
      test the association between predictors and outcome. We included 130 patients, 
      with a mean left ventricular ejection fraction (LVEF) of 33.6 +/- 10.3%. During a 
      follow-up of 52 +/- 31 months, 33 patients died. There were 21 cases of IRM. Heart 
      rate turbulence (HRT) was the only Holter parameter associated with IRM and total 
      mortality. A higher New York Heart Association (NYHA) class and a lower body mass 
      index were the strongest predictors of IRM. Left ventricular ejection fraction 
      predicted IRM on univariate analysis, and was the strongest predictor of total 
      mortality. The only parameter that predicted AI was non-sustained ventricular 
      tachycardia. CONCLUSION: Implantable cardioverter-defibrillator implantation 
      based on NYHA class and LVEF leads to selection of patients with a higher risk of 
      IRM and death. Heart rate turbulence may have added value for the identification 
      of poor candidates for ICD therapy. Available Holter parameters seem limited in 
      their ability to predict AI.
CI  - Published on behalf of the European Society of Cardiology. All rights reserved. (c) 
      The Author 2013. For permissions please email: journals.permissions@oup.com.
FAU - Marynissen, Thomas
AU  - Marynissen T
AD  - Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 
      Leuven, Belgium Department of Cardiovascular Sciences, University of Leuven, 
      Leuven, Belgium.
FAU - Flore, Vincent
AU  - Flore V
AD  - Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 
      Leuven, Belgium Department of Cardiovascular Sciences, University of Leuven, 
      Leuven, Belgium.
FAU - Heidbuchel, Hein
AU  - Heidbuchel H
AD  - Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 
      Leuven, Belgium Department of Cardiovascular Sciences, University of Leuven, 
      Leuven, Belgium.
FAU - Nuyens, Dieter
AU  - Nuyens D
AD  - Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 
      Leuven, Belgium Department of Cardiovascular Sciences, University of Leuven, 
      Leuven, Belgium.
FAU - Ector, Joris
AU  - Ector J
AD  - Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 
      Leuven, Belgium Department of Cardiovascular Sciences, University of Leuven, 
      Leuven, Belgium.
FAU - Willems, Rik
AU  - Willems R
AD  - Department of Cardiology, University Hospitals Leuven, Herestraat 49, 3000 
      Leuven, Belgium Department of Cardiovascular Sciences, University of Leuven, 
      Leuven, Belgium rik.willems@uzleuven.be.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20131106
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
SB  - IM
MH  - Aged
MH  - Body Mass Index
MH  - *Defibrillators, Implantable
MH  - Electric Countershock/adverse effects/*instrumentation/mortality
MH  - Electrocardiography, Ambulatory
MH  - Female
MH  - *Heart Rate
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Myocardial Ischemia/*complications/diagnosis/mortality/physiopathology
MH  - Patient Selection
MH  - Predictive Value of Tests
MH  - Proportional Hazards Models
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Stroke Volume
MH  - Tachycardia, Ventricular/diagnosis/etiology/mortality/*therapy
MH  - Time Factors
MH  - Treatment Failure
MH  - Ventricular Function, Left
OTO - NOTNLM
OT  - Heart rate turbulence
OT  - ICD
OT  - Ischaemic heart disease
OT  - Non-invasive risk stratification
OT  - Sudden cardiac death
EDAT- 2013/11/08 06:00
MHDA- 2015/02/20 06:00
CRDT- 2013/11/08 06:00
PHST- 2013/11/08 06:00 [entrez]
PHST- 2013/11/08 06:00 [pubmed]
PHST- 2015/02/20 06:00 [medline]
AID - eut303 [pii]
AID - 10.1093/europace/eut303 [doi]
PST - ppublish
SO  - Europace. 2014 Jul;16(7):1069-77. doi: 10.1093/europace/eut303. Epub 2013 Nov 6.