PMID- 31153454
OWN - NLM
STAT- MEDLINE
DCOM- 20201028
LR  - 20201028
IS  - 1556-3871 (Electronic)
IS  - 1547-5271 (Linking)
VI  - 16
IP  - 6
DP  - 2019 Jun
TI  - Arrhythmic burden among asymptomatic patients with ischemic cardiomyopathy and an 
      implantable cardioverter-defibrillator.
PG  - 813-819
LID - S1547-5271(19)30299-1 [pii]
LID - 10.1016/j.hrthm.2019.03.030 [doi]
AB  - BACKGROUND: The clinical benefit of primary prevention implantable 
      cardioverter-defibrillator (ICD) therapy in asymptomatic patients (New York Heart 
      Association [NYHA] functional class I) with ischemic cardiomyopathy and left 
      ventricular dysfunction is continually disputed. OBJECTIVE: The purpose of this 
      study was to evaluate the incidence of ventricular arrhythmias, mortality rates, 
      and appropriate device therapies by NYHA class in a prospective national ICD 
      registry. METHODS: The study comprised 1670 consecutive patients with ischemic 
      cardiomyopathy who were implanted with a primary prevention ICD and enrolled in 
      the prospective national Israeli ICD Registry from 2010. The risk for clinical 
      and arrhythmic events was assessed by NYHA class. RESULTS: Asymptomatic patients 
      (NYHA I) composed 19% of the study cohort. Comparison according to NYHA class 
      showed that the highest mortality rate was in the NYHA III-IV group vs NYHA I and 
      NYHA II (10.5% vs 5.4% and 5.8%, respectively; log rank P = .003). Conversely, 
      cumulative incidence of appropriate ICD therapies, corrected for death as a 
      competing risk, were higher among patients with NYHA I (11% vs 7%; P = .021). In 
      a multivariate model, NYHA I vs >/=II remained independently associated with a 
      significant 2-fold risk for appropriate ICD therapy (hazard ratio 2.03; 95% 
      confidence interval 1.28-3.24). CONCLUSION: Our findings indicate that patients 
      with ischemic cardiomyopathy without heart failure symptoms have a higher risk of 
      appropriate ICD therapy compared with symptomatic patients after adjustment for 
      the competing risk of death, suggesting possible incremental benefit of primary 
      ICD implantation in this population.
CI  - Copyright (c) 2019. Published by Elsevier Inc.
FAU - Sabbag, Avi
AU  - Sabbag A
AD  - Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center Ramat Gan, 
      Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, 
      Israel. Electronic address: Dr.Sabbag.avi@gmail.com.
FAU - Glikson, Michael
AU  - Glikson M
AD  - Shaare Zedek Medical Center, Jerusalem, Israel.
FAU - Suleiman, Mahmoud
AU  - Suleiman M
AD  - Cardiology Department, Rambam Health Care Campus, Haifa, Israel.
FAU - Boulos, Monther
AU  - Boulos M
AD  - Cardiology Department, Rambam Health Care Campus, Haifa, Israel.
FAU - Goldenberg, Ilan
AU  - Goldenberg I
AD  - Clinical Cardiovascular Research Center Cardiology Division, University of 
      Rochester Medical Center, Rochester, New York.
FAU - Beinart, Roy
AU  - Beinart R
AD  - Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center Ramat Gan, 
      Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, 
      Israel.
FAU - Nof, Eyal
AU  - Nof E
AD  - Davidai Arrhythmia Center, Leviev Heart Center, Sheba Medical Center Ramat Gan, 
      Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, 
      Israel.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Heart Rhythm
JT  - Heart rhythm
JID - 101200317
SB  - IM
MH  - Aged
MH  - Arrhythmias, Cardiac/complications/epidemiology/*therapy
MH  - Asymptomatic Diseases
MH  - Cardiomyopathies/*complications
MH  - Death, Sudden, Cardiac/epidemiology/etiology/*prevention & control
MH  - *Defibrillators, Implantable
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Incidence
MH  - Israel/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Myocardial Ischemia/*complications
MH  - Primary Prevention/*methods
MH  - Prospective Studies
MH  - Survival Rate/trends
OTO - NOTNLM
OT  - Appropriate therapy
OT  - Competing risk
OT  - Defibrillator
OT  - Ischemic cardiomyopathy
OT  - Primary prevention
EDAT- 2019/06/04 06:00
MHDA- 2020/10/29 06:00
CRDT- 2019/06/03 06:00
PHST- 2018/04/18 00:00 [received]
PHST- 2019/06/03 06:00 [entrez]
PHST- 2019/06/04 06:00 [pubmed]
PHST- 2020/10/29 06:00 [medline]
AID - S1547-5271(19)30299-1 [pii]
AID - 10.1016/j.hrthm.2019.03.030 [doi]
PST - ppublish
SO  - Heart Rhythm. 2019 Jun;16(6):813-819. doi: 10.1016/j.hrthm.2019.03.030.