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Noninvasive diagnostic technique in ventricular tachyarrhythmias assessment in patients with coronary artery disease and secondary prevention indications for ICD implantation

Session Poster Session 4

Speaker Tariel Atabekov

Congress : Heart Failure 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Implantable Cardioverter / Defibrillator
  • Session type : Poster Session
  • FP Number : P1987

Authors : T Atabekov (Tomsk,RU), R Batalov (Tomsk,RU), S Krivolapov (Tomsk,RU), M Khlynin (Tomsk,RU), S Sazonova (Tomsk,RU), A Levintas (Tomsk,RU), A Mishkina (Tomsk,RU), K Zavadovsky (Tomsk,RU), Y Lishmanov (Tomsk,RU), S Popov (Tomsk,RU)

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Authors:
T Atabekov1 , R Batalov1 , S Krivolapov1 , M Khlynin1 , S Sazonova1 , A Levintas1 , A Mishkina1 , K Zavadovsky1 , Y Lishmanov1 , S Popov1 , 1State Research Institute of Cardiology of Tomsk, Heart Arrhythmyas Department - Tomsk - Russian Federation ,

Citation:

Background. Sudden cardiac death (SCD) remains a serious public health problem. Certainly, coronary heart disease (CAD) is the most common cause leading to SCD. SCD in patients with CAD is caused principally ventricular tachyarrhythmias (VTA). The implantable cardioverter-defibrillator (ICD) is one of the most effective interventions for SCD prevention. However, about 25% patients did not receive an ICD therapy during the first 5-years follow-up. So, it’s necessary to find out new predictors of SCD and VTA incidence, which will help to optimize the selection of patients who really need a device implantation.

Purpose. To study the diagnostic value of heart rate variability (HRV) individual parameters analysis, left ventricle ejection fraction (LVEF) assessment and cardiac 123I-methaiodobenzylguanidine (123I-MIBG) scintigraphy in the VTA prediction in patients with CAD and high risk of sudden cardiac death SCD.

Methods. 30 patients (male - 22, female - 8, average age 66,9±8,6 year) with CAD, myocardial infarction and secondary SCD prevention indications were examined. Before ICD implantation, patients underwent echocardiography, HRV individual parameters analysis and cardiac 123I-MIBG scintigraphy. All patients were treated with antiarrhythmic therapy (beta-blockers and amiodarone). All patients were divided into 2 groups according to the incidences VTA events during sixth months’ follow-up. The first group consisted of patients with VTA events, second group - without VTA. Data of HRV, LVEF and cardiac 123I-MIBG scintigraphy before ICD implantation were compared.

Results. The 1-st group consisted of 19 (63,3%) patients with VTA events (male - 15, female - 4, age 66,4±9,1 years). The 2-nd group consisted of 11 (36,7%) patients without VTA events (male - 7, female - 4, age 67,7±8,1 years). There were statistically significant differences between patients with and without VTA before ICD implantation in terms of: LVEF - 50,63±9,22% vs. 64,18±7,96% (p=0,001), low frequencies domain - 719,47±437,83 ms vs. 1385,01±889,98 ms (p=0,01), total frequencies domain - 1910,63±882,04 ms vs. 2830,81±1208,61 ms (p=0,04), summed 123I-MIBG score calculation on early (31,68±17,71% vs. 7,36±2,24% (p=0,0005)) and delayed (33,05±18,08 vs. 9,36±3,93% (p=0,0003)), respectively. Conclusion. HRV assessment, as well as LVEF and cardiac sympathetic activity assessment can be used for identification of SCD highest risk group. But cardiac 123I-MIBG scintigraphy is more powerful predictor of VTA events then heart rate variability and left ventricle systolic function assessment in patients with CAD.

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