Chronic total occlusion of an infarct-related artery: a new predictor of ventricular arrhythmias in primary prevention implantable cardioverter defibrillator patients

被引:35
作者
Di Marco, Andrea [1 ]
Anguera, Ignasi [1 ]
Teruel, Luis [2 ]
Dallaglio, Paolo [1 ]
Gonzalez-Costello, Jose [3 ]
Leon, Valentina [4 ]
Nunez, Elaine [1 ]
Manito, Nicolas [3 ]
Antoni Gomez-Hospital, Joan [2 ]
Sabate, Xavier [1 ]
Cequier, Angel [4 ]
机构
[1] Bellvitge Univ Hosp, Heart Dis Inst, Arrhythmia Unit, Calle Feixa Ilarga S-N,08907 Hosp Llobrega, Barcelona, Spain
[2] Bellvitge Univ Hosp, Heart Dis Inst, Intervent Cardiol Unit, Barcelona, Spain
[3] Bellvitge Univ Hosp, Heart Failure Unit, Barcelona, Spain
[4] Bellvitge Univ Hosp, Heart Dis Inst, Barcelona, Spain
来源
EUROPACE | 2017年 / 19卷 / 02期
关键词
Ventricular arrhythmia; Coronary chronic total occlusion; Ischaemic cardiomyopathy; Implantable cardioverter defibrillator; Primary prevention; HEART-FAILURE; ISCHEMIC CARDIOMYOPATHY; EJECTION FRACTION; ESC GUIDELINES; TACHYCARDIA; IMPACT; MORTALITY; DIAGNOSIS; CHANNEL; DEATH;
D O I
10.1093/europace/euw009
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims The aim of this article is to evaluate the impact of a coronary chronic total occlusion in an infarct-related artery (IRA-CTO) on the occurrence of ventricular arrhythmias (VAs) in patients implanted with an implantable cardioverter defibrillator (ICD) for primary prevention. Methods and results The study includes a prospective cohort of 108 consecutive patients with ischaemic cardiomyopathy, in whom an ICD was implanted for primary prevention and a coronary angiography performed before ICD implantation. About 49 patients (45%) had a CTO and 34 (31%) had an IRA-CTO. Patients with IRA-CTO did not differ from the rest of the population in terms of basal characteristics and severity of cardiac disease. Median follow-up was 33 months (interquartile range 46). Infarct-related artery-CTO was associated with higher rates of any VA (53 vs. 26%, P = 0.006) and fast ventricular tachycardia (fast VT, cycle length,300 ms) or ventricular fibrillation (VF) (47 vs. 19%, P = 0.002). At multivariate Cox regression, IRA-CTO was the only independent predictor of any VA [hazard ratio (HR) 3.64, P = 0.002] and fast VT/VF (HR 3.36, P = 0.008). On the contrary, CTO not associated with a prior infarction in their territory did not increase the risk of VA. Infract-related artery-CTO was also an independent predictor of cardiac mortality or heart transplantation (HR 3.46, P = 0.022). Conclusion In ischaemic patients implanted with an ICD for primary prevention, a CTO associated with a previous infarction in its territory is an independent predictor of VA and, especially, of fast VT/VF, identifying a subgroup of patients with a very high rate of arrhythmic events at follow-up.
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收藏
页码:267 / 274
页数:8
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