SPC365

Prognostic significance of non-sustained ventricular tachycardia on stored electrograms of Heart Failure patients with cardiovascular implantable electronic devices

Session: Posters - C. Arrhythmias and Device Therapy
Speaker: M. Inês Barradas

Congress: CPC 2021
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.6 Device Therapy - Other
Session Type: Posters
FP Number: ---
Authors: M. Inês Barradas; Fabiana Duarte; Luís Oliveira; Cátia Serena; António Fontes; André Monteiro; Carina Machado; Raquel Dourado; Emília Santos; Nuno Pelicano; Miguel Pacheco; Anabela Tavares; Dinis Martins

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><strong><span style="color:#222222">Background:&nbsp;</span></strong><span style="color:#222222"><span style="background-color:white">Non-sustained ventricular tachycardia (NSVT) is commonly found in</span></span><span style="color:#222222"> <span style="background-color:white">patients with structural heart disease and was historically obtained from registers of</span> <span style="background-color:white">external ambulatory monitoring. The advent of Cardiac implantable electronic devices (CIEDs) has made it possible to detect asymptomatic NSVT in Heart Failure (HF) patients more frequently, but its true impact in real world is uncertain, and often does not lead to a change in clinical intervention.</span><br />
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<strong>Purpose:&nbsp;</strong><span style="background-color:white">To determine the prognostic significance of NSVT detection on stored electrograms of CIEDs in HF patients with systolic left ventricle dysfunction.</span></span></span></span></span></p>

<p style="text-align:justify"><br />
<span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><span style="color:#222222"><strong>Methods:&nbsp;</strong><span style="background-color:white">We retrospectively enrolled 132 consecutive HF patients (mean age 67,5&nbsp;</span></span><span style="font-family:Symbol"><span style="color:#222222"><span style="background-color:white">&plusmn;&nbsp;</span></span></span><span style="color:#222222"><span style="background-color:white">11,1 years, males 72,0%) with systolic left ventricle dysfunction and CIEDs (biventricular pacemakers with or without cardiac defibrillators). Patients were evaluated through CIEDs interrogation and clinical evaluations and divided into NSVT positive (Group 1) and negative groups (Group 2). Mean follow-up period was 62,8&nbsp;</span></span><span style="font-family:Symbol"><span style="color:#222222"><span style="background-color:white">&plusmn;&nbsp;</span></span></span><span style="color:#222222"><span style="background-color:white">7,1 months.</span></span></span></span></span></p>

<p style="text-align:justify"><br />
<span style="font-size:medium"><span style="font-family:Calibri"><span style="color:#000000"><span style="color:#222222"><strong>Results:&nbsp;</strong><span style="background-color:white">NSVT was detected in 51 (38,6%) patients. 70 (53,0%) had implantable cardiac resynchronization therapy&nbsp;</span>(CRT) <span style="background-color:white">defibrillator (CRT-D), 37 (28,0%) transvenous implantable cardioverter defibrillator (ICD), 13 (9,8%) CRT pacemaker (CRT-P) and 12 (9,1%) subcutaneous ICD (S-ICD).</span> <span style="background-color:white">Medium left ventricular ejection fraction (LVEF) was 31,1&nbsp;</span></span><span style="font-family:Symbol"><span style="color:#222222"><span style="background-color:white">&plusmn;&nbsp;</span></span></span><span style="color:#222222"><span style="background-color:white">7,9%, 20,6% were in NYHA III-IV and 47,0% were ischemic (</span></span>49% Group 1 and 45,7% Group 2, p=0,708<span style="color:#222222"><span style="background-color:white">). </span></span>Dyslipidemia was more prevalent in Group 2 (p=0,042). <span style="color:#222222"><span style="background-color:white">In total 11 (8,3%) patients died, 2 (1,5%) from sudden cardiac death and 5 (3,8%) from cardiovascular death.</span></span><u> </u><span style="color:#222222"><span style="background-color:white">NSVT was associated with CIEDs treatments (hazard ratio </span></span><span style="font-family:Symbol"><span style="color:#222222"><span style="background-color:white">[</span></span></span><span style="color:#222222"><span style="background-color:white">HR</span></span><span style="font-family:Symbol"><span style="color:#222222"><span style="background-color:white">]:&nbsp;</span></span></span><span style="color:#222222"><span style="background-color:white">2,52; 95% confidence interval </span></span><span style="font-family:Symbol"><span style="color:#222222"><span style="background-color:white">[</span></span></span><span style="color:#222222"><span style="background-color:white">CI</span></span><span style="font-family:Symbol"><span style="color:#222222"><span style="background-color:white">]:&nbsp;</span></span></span><span style="color:#222222"><span style="background-color:white">1,2-5,1; p=0,001), ventricular fibrillation (VF) (HR: 3,71, 95%CI: 1,19-11,58; p=0,018), sustained ventricular tachycardia (VT) (HR: 9,06, 95% CI: 2,82-29,12;</span></span><span style="color:#222222"> <span style="background-color:white">p&lt;0,05) and composite outcome of VT, VF, HF re-admissions and related admissions to emergency department (ED) and death by all causes (HR: 2,52;</span> <span style="background-color:white">95% CI: 1,20-5,10; p=0,011).&nbsp;NSVT at 1 year was associated with HF readmissions at 1</span> <span style="background-color:white">year (p=0,004).</span><br />
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<strong>Conclusions:&nbsp;</strong>On extended monitoring possible with CIEDs, NSVT in HF patients was associated with a worse prognosis and may serve as a predictor of significant arrhythmic events, HF hospitalizations and mortality. These findings enhances the importance of remote monitoring and optimization of therapeutic modalities in these patients along with a close supervision.</span></span></span></span></p>