Long-Term Outcomes Among a Nationwide Cohort of Patients Using an Implantable Cardioverter-Defibrillator: UMBRELLA Study Final Results
Por:
Briongos-Figuero, S, Garcia-Alberola, A, Rubio, J, Segura, JM, Rodriguez, A, Peinado, R, Alzueta, J, Martinez-Ferrer, JB, Vinolas, X, de la Concha, JF, Anguera, I, Martin, M, Cerda, L, Perez, L
Publicada:
5 ene 2021
Resumen:
BACKGROUND: Large-scale studies describing modern populations using an implantable cardioverter-defibrillator (ICD) are lacking. We aimed to analyze the incidence of arrhythmia, device interventions, and mortality in a broad spectrum of real-world ICD patients with different heart disorders.
METHODS AND RESULTS: The UMBRELLA study is a prospective, multicenter, nationwide study of contemporary patients using an ICD followed up by remote monitoring, with a blinded review of arrhythmic episodes. From November 2005 to November 2017, 4296 patients were followed up. After 46.6 +/- 27.3 months, 16 067 episodes of sustained ventricular arrhythmia occurred in 1344 patients (31.3%). Appropriate ICD therapy occurred in 27.3% of study population. Patients with ischemic cardiomyopathy (hazard ratio [HR], 1.51; 95% CI, 1.29-1.78), dilated cardiomyopathy (HR, 1.28; 95% CI, 1.07-1.53), and valvular heart disease (HR, 1.94; 95% CI, 1.43-2.62) exhibited a higher risk of appropriate ICD therapies, whereas patients with hypertrophic cardiomyopathy (HR, 0.72; 95% CI, 0.54-0.96) and Brugada syndrome (HR, 0.25; 95% CI, 0.14-0.45) showed a lower risk. All-cause death was 13.4% at follow-up. Ischemic cardiomyopathy (HR, 3.09; 95% CI, 2.58-5.90), dilated cardiomyopathy (HR, 3.33; 95% CI, 2.18-5.10), and valvular heart disease (HR, 3.97; 95% CI, 2.25-6.99) had the worst prognoses. Delayed high-rate detection was enabled in 39.7% of patients, and single-zone programming occurred in 52.6% of primary prevention patients. Both parameters correlated with lower risk of first appropriate ICD therapy, with no excess risk of mortality. The rate of inappropriate shocks at follow-up was low (6%) and did not differ among type of ICD but was lower in SmartShock-capable devices.
CONCLUSIONS: Irrespective of the cause, contemporary ICD patients with heart failure-related disorders had a similar risk of ICD life-saving interventions and death. Current ICD programming recommendations still need to be implemented.
Filiaciones:
Briongos-Figuero, S:
Hosp Univ Infanta Leonor, Madrid, Spain
Univ Complutense Madrid, Madrid, Spain
Garcia-Alberola, A:
Hosp Virgen Arrixaca, Murcia, Spain
Rubio, J:
Hosp Clin Univ Valladolid, Valladolid, Spain
Segura, JM:
Hosp Reina Sofia Cordoba, Cordoba, Spain
Rodriguez, A:
Hosp Univ Canarias, Santa Cruz De Tenerife, Spain
Peinado, R:
Hosp Univ La Paz, Madrid, Spain
Alzueta, J:
Hosp Univ Virgen Victoria, Malaga, Spain
Martinez-Ferrer, JB:
Hosp Univ Araba, Alava, Spain
Vinolas, X:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
de la Concha, JF:
Hosp Infanta Cristina, Badajoz, Spain
Anguera, I:
Hosp Univ Bellvitge, Barcelona, Spain
Martin, M:
Medtronic Iber, Madrid, Spain
Cerda, L:
Medtronic Iber, Madrid, Spain
Perez, L:
Complexo Hosp Univ A Coruna, La Coruna, Spain
gold, Green Published
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