CLINICAL RESEARCH: CARDIAC RHYTHM DISORDERS
Factors Influencing Appropriate Firing of the Implanted Defibrillator for Ventricular Tachycardia/Fibrillation
Findings From the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II)
Jagmeet P. Singh, MD, PhD*,*,
W. Jackson Hall, PhD ,
Scott McNitt, MS ,
Hongyue Wang, MA,
James P. Daubert, MD,
Wojciech Zareba, MD,
Jeremy N. Ruskin, MD*,
Arthur J. Moss, MD and the MADIT-II Investigators
* Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Department of Biostatistics and Computational Biology
Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, New York
Manuscript received February 2, 2005;
revised manuscript received April 11, 2005,
accepted May 10, 2005.
* Reprint requests and correspondence: Dr. Jagmeet P. Singh, GRB 109, Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114 (Email: jsingh{at}partners.org).
OBJECTIVES: The purpose of this study was to prospectively examine the role of clinical, laboratory, echocardiographic, and electrophysiological variables as predictors of appropriate initial implantable cardioverter-defibrillator (ICD) therapy for ventricular tachycardia (VT) or ventricular fibrillation (VF) or death in the Multicenter Automatic Defibrillator Implantation Trial II (MADIT-II) population.
BACKGROUND: There is limited information regarding the determinants of appropriate ICD therapy in patients with reduced ventricular function after a myocardial infarction.
METHODS: We used secondary analysis in one arm of a multicenter randomized clinical trial in patients with a previous myocardial infarction and reduced left ventricular function.
RESULTS: We analyzed baseline and follow-up data on 719 patients enrolled in the ICD arm of the MADIT-II study. Appropriate ICD therapy was observed in 169 subjects. Clinical, laboratory, echocardiographic, and electrophysiological variables, along with measures of clinical instability such as interim hospitalization for congestive heart failure (IH-CHF) and interim hospitalization for coronary events (IH-CE), were examined with proportional hazards models and Kaplan-Meier time-to-event curves before and after first interim hospitalization. Interim hospitalization-CHF, IH-CE, no beta-blockers, digitalis use, blood urea nitrogen (BUN) >25, body mass index (BMI)  30 kg/m2, and New York Heart Association functional class >II were associated with increased risk for appropriate ICD therapy for VT, VF, or death. In a multivariate (stepwise selection) analysis, IH-CHF was associated with an increased risk for the end point of either VT or VF (hazard ratio [HR] 2.52, 95% confidence interval [CI] 1.69 to 3.74, p < 0.001) and for the combined end point of VT, VF, or death (HR 2.97, 95% CI 2.15 to 4.09, p < 0.001). Interim hospitalization-CE was associated with an increased risk for VT, VF, or death (HR 1.66, 95% CI 1.09 to 2.52, p = 0.02).
CONCLUSIONS: These results provide important mechanistic information, suggesting that worsening clinical condition and cardiac instability, as reflected by an IH-CHF or IH-CE, are subsequently associated with a significant increase in the risk for appropriate ICD therapy (for VT/VF) and death.
|
Abbreviations and Acronyms
| | BMI = body mass index | | BUN = blood urea nitrogen | | CE = coronary events | | CHF = congestive heart failure | | CI = confidence interval | | HR = hazard ratio | | ICD = implantable cardioverter-defibrillator | | IH = interim hospitalization | | LVEF = left ventricular ejection fraction | | MADIT-II = Multicenter Automatic Defibrillator Implantation Trial II | | MI = myocardial infarction | | NYHA = New York Heart Association | | VF = ventricular fibrillation | | VT = ventricular tachycardia |
|
This article has been cited by other articles:
|
|
|
|
 
A. S. Adabag, T. M. Therneau, B. J. Gersh, S. A. Weston, and V. L. Roger
Sudden Death After Myocardial Infarction
JAMA,
November 5, 2008;
300(17):
2022 - 2029.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al.
American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention
J. Am. Coll. Cardiol.,
September 30, 2008;
52(14):
1179 - 1199.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Goldberger, M. E. Cain, S. H. Hohnloser, A. H. Kadish, B. P. Knight, M. S. Lauer, B. J. Maron, R. L. Page, R. S. Passman, D. Siscovick, et al.
American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society Scientific Statement on Noninvasive Risk Stratification Techniques for Identifying Patients at Risk for Sudden Cardiac Death: A Scientific Statement From the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention
Circulation,
September 30, 2008;
118(14):
1497 - 1518.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. S. Cannom and B. Gidney
Azimilide: Another Effort to Prevent Implantable Cardioverter-Defibrillator Shocks and Their Sequelae: Why it Is Important and How it Works
J. Am. Coll. Cardiol.,
September 23, 2008;
52(13):
1084 - 1085.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Buck, A. H. Maass, and I. C. Van Gelder
How to prevent ICD shocks: part II
Europace,
September 1, 2008;
10(9):
1126 - 1129.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. T. Koller, B. Schaer, M. Wolbers, C. Sticherling, H. C. Bucher, and S. Osswald
Death Without Prior Appropriate Implantable Cardioverter-Defibrillator Therapy: A Competing Risk Study
Circulation,
April 15, 2008;
117(15):
1918 - 1926.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G Lin, R F Rea, S C Hammill, D L Hayes, and P A Brady
Effect of cardiac resynchronisation therapy on occurrence of ventricular arrhythmia in patients with implantable cardioverter defibrillators undergoing upgrade to cardiac resynchronisation therapy devices
Heart,
February 1, 2008;
94(2):
186 - 190.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Khairy, L. Harris, M. J. Landzberg, S. Viswanathan, A. Barlow, M. A. Gatzoulis, S. M. Fernandes, L. Beauchesne, J. Therrien, P. Chetaille, et al.
Implantable Cardioverter-Defibrillators in Tetralogy of Fallot
Circulation,
January 22, 2008;
117(3):
363 - 370.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Jung and B. Schumacher
What is the role of risk stratification for sudden death in the defibrillator era?
Eur. Heart J. Suppl.,
December 1, 2007;
9(suppl_I):
I59 - I65.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Worck, J. Haarbo, and P. E. B. Thomsen
Electrophysiological study and 'slow' ventricular tachycardia predict appropriate therapy: results from a single-centre implantable cardiac defibrillator follow-up
Europace,
November 1, 2007;
9(11):
1048 - 1053.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Goldenberg, A. J. Moss, S. McNitt, W. Zareba, W. J. Hall, M. L. Andrews, and for the MADIT-II Investigators
Inverse Relationship of Blood Pressure Levels to Sudden Cardiac Mortality and Benefit of the Implantable Cardioverter-Defibrillator in Patients With Ischemic Left Ventricular Dysfunction
J. Am. Coll. Cardiol.,
April 3, 2007;
49(13):
1427 - 1433.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. H. Schoenfeld
Contemporary Pacemaker and Defibrillator Device Therapy: Challenges Confronting the General Cardiologist
Circulation,
February 6, 2007;
115(5):
638 - 653.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. C. Huynh, A. Rovner, and M. W. Rich
Long-term Survival in Elderly Patients Hospitalized for Heart Failure: 14-Year Follow-up From a Prospective Randomized Trial.
Arch Intern Med,
September 25, 2006;
166(17):
1892 - 1898.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. M. Scheinman and E. Keung
The Year in Clinical Electrophysiology
J. Am. Coll. Cardiol.,
March 21, 2006;
47(6):
1207 - 1213.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. D. Fisher
Who Needs a Defibrillator?: The Beat Goes On
J. Am. Coll. Cardiol.,
November 1, 2005;
46(9):
1727 - 1728.
[Full Text]
[PDF]
|
|
|
|
