Incidence of arrhythmias in a large cohort of patients with current implantable cardioverter-defibrillators in Spain: results from the UMBRELLA Registry
Por:
Fontenla, A, Martinez-Ferrer, JB, Alzueta, J, Vinolas, X, Garcia-Alberola, A, Brugada, J, Peinado, R, Sancho-Tello, MJ, Cano, A, Fernandez-Lozano, I
Publicada:
1 nov 2016
Resumen:
The benefit of implantable cardioverter-defibrillators (ICDs) in patients at risk of sudden death has been established in randomized clinical trials (RCTs) using the ICD models available at the time. However, observational large-scale data on the incidence of arrhythmias in up-to-date ICDs implanted according to the current guidelines are scarce. The aim was to assess the incidence of arrhythmias in a large, current ICD population based on a blinded peer review of the detected episodes.
UMBRELLA is a multicentre, observational registry of ICD patients followed by remote monitoring. Stored episodes were classified by a blinded committee of experts. Subgroup analyses were based on clinical profiles established by previous pivotal RCTs of ICDs. Of 1514 enrolled patients, 605 (39.9%) patients had 5951 episodes after 26 +/- 17 months follow-up, being 3353 of them (56.3%) sustained ventricular arrhythmias (SVA), and 13.2% of SVA were self-terminated. Appropriate and inappropriate shocks occurred in 11.6 and 5% of patients, respectively. The 3 years cumulative incidence of SVA was 25% (95% CI: 21-28%) in primary prevention patients and 41% (95% CI: 36-47%) in secondary prevention patients (P < 0.001). Male gender, secondary prevention, and atrial fibrillation as basal rhythm were significantly related to a higher incidence of SVA.
This real-world analysis suggests that modern ICD patients have a low rate of appropriate and inappropriate shocks. The risk of SVA in secondary prevention patients is less than what has been reported in RCTs.
Filiaciones:
Fontenla, A:
Univ Hosp 12 Octubre, Ave Corodoba Sn, Madrid 28041, Spain
Martinez-Ferrer, JB:
Univ Hosp Araba, Calle Jose Itxotegi Sn, Vitoria 01009, Alava, Spain
Alzueta, J:
Univ Hosp Virgen de las Victoria, Campus Teatinos Sn, Malaga 29010, Spain
Vinolas, X:
Hosp Santa Creu & Sant Pau, Carrer St Quinti 89, Barcelona 08026, Spain
Garcia-Alberola, A:
Univ Hosp Virgen de la Arrixaca, Ronda Levante 11, Murcia 30008, Spain
Brugada, J:
Hosp Clin Barcelona, Carrer Villarroel 170, Barcelona 08036, Spain
Peinado, R:
Univ Hosp La Paz, Paseo Castellana 261, Madrid 28046, Spain
Sancho-Tello, MJ:
Univ Hosp La Fe, Ave Campanar 21, Valencia 46026, Spain
Cano, A:
Medtron Iber, Cardiac & Vasc Grp, Calle Maria de Portugal 9, Madrid 28050, Spain
Fernandez-Lozano, I:
Univ Hosp Puerta de Hierro Majadahonda, Calle Manuel de Falla 1, Madrid 28222, Spain
Open Access
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