Life-threatening ventricular arrhythmias (VA) and electrical storm (ES) are conditions associated with high mortality. Patients with heart failure and coronary artery disease (CAD) are more likely to be affected by VA than the patients with non-ischemic background of heart failure (HF).
The aim of this analysis was to compare the risk of appropriate interventions of cardioverters-defibrillators (ICD) or resynchronization therapy and cardioverters-defibrillators (CRT-D) and ES in patients of ischemic and non-ischemic background of HF in patients with ICD or CRT-D and remote monitoring.
We analyzed data from COMMIT-HF registry of 2730 patients with left ventricle ejection fraction (LVEF) of 35% or less admitted to Silesian Centre for Heart Diseases in 2009-2015, in whom acute coronary syndrome was excluded at admission. 1791 patients had implanted ICD or CRT-D and 553 patients had active remote monitoring system by one of three main manufacturers (Medtronic, Biotronik, St Jude Medical). The mean follow-up was 1560 days. Clinical history, results of diagnostic investigations and treatment were collected for all patients. Follow-up data were collected from hospital documentation, outpatient clinic and remote monitoring systems.
In the whole population, 3,9% of patients had ES and 16,8% experienced appropriate interventions (antytachycardia pacing or high voltage) of ICD or CRT-D. Within the population, we divided patients into two groups: with ischemic (n=345) and non-ischemic (n=208) background of HF. In the group with ischemic background of HF ES was experienced by 4,93% of patients vs 2,4% in the group of patients with non-ischemic background of HF (p=0,16). Appropriate ICD/CRT-D interventions were observed in 18,5% vs 13,9% of patients (p=0,14), respectively. The group of patients with HF of ischemic etiology was analyzed in regard to the level of advancement of CAD: incidence of ES in patients with single vessel disease was 3,6%, in 2 vessel disease – 5,3% and in ³3 vessel CAD it was 5,5%. Incidence of appropriate ICD/CRT-D interventions in patients with single vessel disease was 16,6%, in 2 vessel disease – 18,7% and in 3 vessel CAD it was 19,4%.
Patients with ischemic etiology of HF are more prone to experience appropriate ICD/CRT-D interventions as well as ES. The possibility of lethal VA is growing in parallel to the level of advancement of CAD and can be mostly expected in patients with multivessel coronary artery disease.