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32. Cardiovascular Nursing
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Primary prevention implantation of Cardioverter Defibrillators in truly asymptomatic patients – should we rethink current recommendations?
Session:
Posters (Sessão 5 - Écran 2) - Arritmias 5 - Foco na Insuficiência Cardíaca
Speaker:
Fabiana Duarte
Congress:
CPC 2022
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
09.2 Implantable Cardioverter / Defibrillator
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Fabiana Silva Duarte; m. Inês Barradas; André Viveiros Monteiro; Luís Oliveira; Cátia Serena; António Fontes; Carina Machado; Raquel Dourado; Emília Santos; Nuno Pelicano; Miguel Pacheco; Anabela Tavares; Dinis Martins
Abstract
<p>Introduction: Implantable cardioverter defibrillator (ICD) implantation is recommended as primary prevention in symptomatic heart failure (HF) patients with reduced ejection fraction. However, there are conflicting data regarding the real benefit of prophylactic ICD treatment in New York Heart Association (NYHA) class I patients in which the eligibility remains ambiguous and based on the physicians’ judgement and patients preference.<br /> <br /> Objective: To determine the clinical impact of ICD therapy in primary prevention and assessed differences in patients with NYHA I vs other classes.<br /> <br /> Methods: Retrospective single center cohort study including HF patients undergoing prophylactic ICD implantation. We divided patients according to their NYHA class and analyse cardiovascular death, all-cause mortality, arrhythmic events, appropriate device therapy (ADT) and hospitalizations due to HF decompensation.<br /> <br /> Results: Seventy-six HF patients were accessed between April 2007 and January 2021, during a follow-up period of 49 ± 43,6 months. Mean age was 61,2 ± 9,7 years, 66 (86,8%) patients were male.<br /> At baseline, 29 (34,5%) were in NYHA I (Group 1), 34 (40,5%) in NYHA II (Group 2) and 12 (14.3%) in NYHA III/IV (Group 3). Fifty-one (67%) of all patients had ischemic etiology. No particular differences in baseline characteristics between groups were seen. Overall 7.9% of patients had significant ventricular arrhythmias (sustained ventricular tachycardia and/or ventricular fibrillation) and 39.5% had hospital admissions by HF decompensation. All-cause mortality were seen in 10.5% and cardiovascular death in 6.6%. During follow-up Group 1 had more non-sustained ventricular tachycardia (28.9% vs 13.2% vs 10.5%, p=0.034 ) and appropriate ICD therapy (18.8% vs 11.6% vs 1.4%,p=0.027). At multivariable analysis, obesity and atrial fibrillation were a significant predictors of ventricular arrhythmias but not NYHA class.<br /> <br /> Conclusion: Heart failure patients with a reduced ejection fraction, even if asymptomatic, are at increased risk of significant arrhythmic events, and should therefore be considered for prophylactic ICD implantation. Future studies focusing in asymptomatic HF patients are needed to evaluate the value of ICD therapy in the modern era.</p>
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