PMID- 33998405
OWN - NLM
STAT- MEDLINE
DCOM- 20210518
LR  - 20210518
IS  - 0022-9040 (Print)
IS  - 0022-9040 (Linking)
VI  - 61
IP  - 4
DP  - 2021 May 4
TI  - The Necessity of an ICD-Therapy in Patients with Indications for Primary 
      Prevention of Sudden Cardiac Death. One Center Experience.
PG  - 24-31
LID - 10.18087/cardio.2021.4.n1335 [doi]
AB  - Aim      Analysis of responses of cardioverter-defibrillators implanted in 
      patients with cardiomyopathies (CMPs) of various origins and a high risk of 
      sudden cardiac death (SCD) to assess the effectiveness of a modern strategy for 
      primary prevention of SCD.Material and methods  In the Federal Center for High 
      Medical Technologies in Kaliningrad from 2014 through 2018, implantable 
      cardioverter-defibrillators (ICD) and cardiac resynchronization therapy 
      defibrillators (CRT-D) were installed in 165 patients. Major indications for 
      device implantation in these patients included left ventricular (LV) systolic 
      dysfunction with ejection fraction (EF) </=35 %; chronic heart failure (CHF) 
      consistent with the New York Heart Association (NYHA) functional class (FC) 
      II-III (IV for CRT-D) without previous episodes of life-threatening ventricular 
      arrhythmias, circulatory arrest and resuscitation, which was consistent with the 
      current international strategy for primary prevention of SCD. The study patients 
      were divided into two groups based on the CMP origin; group 1 included 101 
      (61.2 %) patients with CMP of ischemic origin (ICMP) and group 2 consisted of 64 
      (38.8 %) patients with CMP of non-ischemic origin (NCMP). Information about 
      arrhythmic episodes and device activation was retrieved from the device 
      electronic memory during visits of patients to the clinic and was also 
      transmitted to the clinic by a remote monitoring system. This information was 
      studied and evaluated for the validity and effectiveness of the device 
      triggering. If necessary, the parameters of detection and treatment were adjusted 
      taking into account the obtained information. Information was analyzed and 
      statistically processed with the SPSS Statistics 20.0 software.Results The 
      patients were followed up for 28.3 +/- 15.6 months, during which the devices 
      delivered therapy to 55 (33.3%) patients of the entire group. In the ICMP group, 
      the devices were activated in 44 (26.7 %) patients and in the NCMP group, the 
      devices were activated in 11 (6.7 %) patients. In group 1 (ICMP), appropriate 
      triggering was observed in 33 (20.0%) patients and inappropriate triggering was 
      observed in 11 (6.7%) patients. In group 2 (NCMP), appropriate triggering was 
      observed in 2 (1.2 %) patients and inappropriate triggering was observed in 9 
      (5.5 %) patients. The main cause of inappropriate triggering was atrial 
      fibrillation (AF). 17 (10.3 %) patients with ICMP had sustained ventricular 
      tachycardia (VT), which did not reach the detection frequency for ICD therapy; 
      these VTs were only detected by devices and terminated spontaneously. Intragroup 
      differences in the number of patients who received an appropriate treatment were 
      statistically significant: 33 (32.6 %) in the ICMP group vs. 2 (3.1 %) in the 
      NCMP group (small er, Cyrillic&lt;0.006). Differences in the number of patients who received an 
      inappropriate treatment were not statistically significant although their number 
      was greater in the NCMP group than in the ICMP group (9 (14.1 %) vs. 11 (10.9 %), 
      small er, Cyrillic&gt;0.05).Conclusion      A higher requirement for the ICD treatment was 
      revealed in patients with ICMP compared to patients with NCMP. The low demand for 
      the ICD treatment in patients with NCMP and the more frequent inappropriate 
      actuation of the devices in this patient group due to AF allow a conclusion that 
      the criteria for primary prevention of SCD with ICD (LV EF </=35% and clinically 
      significant CHF) are not equally effective indications for ICD implantation in 
      patients with ICMP and NCMP. It can be assumed that life-threatening ventricular 
      arrhythmias are evident in patients with NCMP before the development of 
      hemodynamically significant LV dysfunction and CHF, which warrants further 
      research in this direction.
FAU - Postol, A S
AU  - Postol AS
AD  - Federal centers of High Medical Technologies Health Ministry Russian Federation, 
      Kaliningrad.
FAU - Neminushchiy, N M
AU  - Neminushchiy NM
AD  - Sechenov First Moscow State Medical University, Moscow.
FAU - Antipov, G N
AU  - Antipov GN
AD  - Federal centers of High Medical Technologies Health Ministry Russian Federation, 
      Kaliningrad.
FAU - Ivanchenko, A V
AU  - Ivanchenko AV
AD  - Federal centers of High Medical Technologies Health Ministry Russian Federation, 
      Kaliningrad.
FAU - Lyashenko, V V
AU  - Lyashenko VV
AD  - Federal centers of High Medical Technologies Health Ministry Russian Federation, 
      Kaliningrad.
FAU - Vygovsky, A B
AU  - Vygovsky AB
AD  - Federal centers of High Medical Technologies Health Ministry Russian Federation, 
      Kaliningrad.
FAU - Shnejder, Yu A
AU  - Shnejder YA
AD  - Federal centers of High Medical Technologies Health Ministry Russian Federation, 
      Kaliningrad.
LA  - rus
LA  - eng
PT  - Journal Article
DEP - 20210504
PL  - Russia (Federation)
TA  - Kardiologiia
JT  - Kardiologiia
JID - 0376351
SB  - IM
MH  - *Cardiac Resynchronization Therapy
MH  - Death, Sudden, Cardiac/etiology/prevention & control
MH  - *Defibrillators, Implantable
MH  - Humans
MH  - Primary Prevention
MH  - *Tachycardia, Ventricular/therapy
EDAT- 2021/05/18 06:00
MHDA- 2021/05/19 06:00
CRDT- 2021/05/17 08:48
PHST- 2020/08/17 00:00 [received]
PHST- 2021/01/29 00:00 [accepted]
PHST- 2020/12/25 00:00 [revised]
PHST- 2021/05/17 08:48 [entrez]
PHST- 2021/05/18 06:00 [pubmed]
PHST- 2021/05/19 06:00 [medline]
AID - 10.18087/cardio.2021.4.n1335 [doi]
PST - epublish
SO  - Kardiologiia. 2021 May 4;61(4):24-31. doi: 10.18087/cardio.2021.4.n1335.