Influence of Diabetes Mellitus on Inappropriate and Appropriate Implantable Cardioverter-Defibrillator Therapy and Mortality in the Multicenter Automatic Defibrillator Implantation Trial–Reduce Inappropriate Therapy (MADIT-RIT) Trial

Ruwald, Martin H.; Zaręba, Wojciech; Jøns, Christian; Zhang, Claire; Ruwald, Anne‐Christine; Olshansky, Brian; McNitt, Scott; Thomsen, Poul Erik Bloch; Shoda, Morio; Merkely, Béla; Moss, Arthur J.; Kutyifa, Valentina

doi:10.1161/circulationaha.113.002472

Cited by 25 publications

(24 citation statements)

References 41 publications

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“…Both arms (ii) and (iii) were associated with a significant reduction in appropriate and inappropriate ICD therapy [29•]. In addition to more ICD shocks, there was a significant three-five fold greater use of ATP in the conventional programming control arm versus the comparator arms.…”

Section: Limitations Of the S-icd: Bradycardia Pacing And Anti-tachycmentioning

confidence: 99%

Early Experience with the Subcutaneous ICD

Lambiase

Srinivasan

2014

Curr Cardiol Rep

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The Subcutaneous Internal Cardiac Defibrillator (S-ICD) represents a major advance in the care of patients who have an indication for an internal cardiac defibrillator without pacing indications. Its main advantage is that it can deliver a shock to cardiovert ventricular arrhythmias utilising a tunnelled subcutaneous lead, negating the risks associated with conventional transvenous systems. Initial studies have shown comparable efficacy in cardioversion of induced and spontaneous ventricular tachycardia (VT) and ventricular fibrillation (VF) when compared to conventional transvenous systems. In addition, inappropriate shocks occurred in a similar percentage of patients to conventional ICD studies. Complication rates are low and relate largely to localised wound infections, treated successfully with antibiotics. The long term efficacy of the device is yet to be ascertained, however, a randomised trial & prospective registries are currently in progress to enable direct comparison with transvenous ICDs. This article summarises the early clinical experience and trials in the implantation of the S-ICD.

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Section: Limitations Of the S-icd: Bradycardia Pacing And Anti-tachycmentioning

confidence: 99%

Early Experience with the Subcutaneous ICD

Lambiase

Srinivasan

2014

Curr Cardiol Rep

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“…For example, in a study of 194 006 patients with an ICD, Saxon and colleagues reported an ICD discharge rate of ≈18% over a similar follow‐up period 44. The mechanisms for the small differences in ICD discharge rate in our presumed uninfected population are unclear but are likely, in part, mediated by a high background prevalence of diabetes mellitus,46 cocaine use,26 and the lower rate of cardiac resynchronization therapy use 47. Finally, the interpretation of the ICD data was derived from the EHR from the interpretation of a board‐certified electrophysiologist and was not independently reviewed.…”

Section: Discussionmentioning

confidence: 88%

Incidence, Predictors, and Outcomes of Implantable Cardioverter‐Defibrillator Discharge Among People Living With HIV

Alvi

Neilan

Tariq

et al. 2018

JAHA

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BackgroundPeople living with HIV (PHIV) are at an increased risk for sudden cardiac death, and implantable cardioverter‐defibrillators (ICDs) prevent SCD. There are no data on the incidence, predictors, and effects of ICD therapies among PHIV.Methods and ResultsWe compared ICD discharge rates between 59 PHIV and 267 uninfected controls. For PHIV, we tested the association of traditional cardiovascular risk factors and HIV‐specific parameters with an ICD discharge and then tested whether an ICD discharge among PHIV was associated with cardiovascular mortality or an admission for heart failure. The indication for ICD insertion was similar among groups. Compared with controls, PHIV with an ICD were more likely to have coronary artery disease and to use cocaine. In follow‐up, PHIV had a higher ICD discharge rate (39% versus 20%; P=0.001; median follow‐up period, 19 months). Among PHIV, cocaine use, coronary artery disease, QRS duration, and higher New York Heart Association class were associated with an ICD discharge. An ICD discharge had a prognostic effect, with a subsequent 1.7‐fold increase in heart failure admission and a 2‐fold increase in cardiovascular mortality, an effect consistent across racial/ethnic and sex categories.Conclusions ICD discharge rates are higher among PHIV compared with uninfected controls. Among PHIV, cocaine use and New York Heart Association class are associated with increased ICD discharge, and an ICD discharge is associated with a subsequent increase in admission for heart failure and cardiovascular mortality.

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“…This is in concordance with the post hoc sub group analyses of the comparison of medical therapy, pacing, and defibrillation in heart failure (COMPANION) and multicenter automatic defibrillator implantation trial (MADIT)II trials that did not find an increased rate of appropriate therapies in the DM cohort [28,29]. However, a recent sub-study of the multicenter automatic defibrillator implantation trial-reduce inappropriate therapy (MADIT RIT) did find that DM patients had a 58% increased risk of appropriate therapy (p = 0.003), but a 46% decreased risk of inappropriate therapy (p = 0.002) compared to no DM patients during a mean follow up of 17 months [14]. The authors suggested that the increased risk for appropriate ICD therapy might be explained by a reduced autonomic function or vulnerable myocardium resulting from ischemia and fibrosis in DM patients rendering the myocardium more prone to produce ventricular arrhythmias.…”

Section: Discussionmentioning

confidence: 98%

“…DM is a risk factor for development of atrial fibrillation [7,13,[36][37][38] and indeed, more of our patients had atrial fibrillation (Table 1), a major cause of inappropriate shocks, and it would be anticipated that the rate of inappropriate shocks would be increased. Evidence based programming of these devices has greatly decreased the rate of inappropriate therapies especially in diabetics [14] and indeed several centers contributing to the registry were participants in successful programming trials during the course of follow up, which may explain why there was no difference in the rate of inappropriate therapies [14,39].…”

Section: Discussionmentioning

confidence: 99%

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176-54: Characteristics and Outcomes of Diabetic Patients with an Implantable Cardioverter Defibrillator in a Real World Setting: Results From the Israeli ICD Registry

Steiner¹,

Goldenberg²,

Suleiman

et al. 2016

EP Europace

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Aims: There are limited data regarding the effect of diabetes mellitus (DM) on the risks of both appropriate and inappropriate implantable cardioverter defibrillator (ICD) therapy. The present study was designed to compare the outcome of appropriate and inappropriate ICD therapy in patients with or without DM. Methods and results:The risk of a first appropriate ICD therapy for ventricular tachyarrhythmias (including anti tachycardia pacing and shock) was compared between 764 DM and 1346 non-DM patients enrolled in the national Israeli ICD registry. We also compared the risks of inappropriate ICD therapy, and death or cardiac hospitalization between diabetic and non-diabetic patients. Diabetic patients were older, were more likely to have ischemic cardiomyopathy, lower ejection fraction, atrial fibrillation, and other co-morbidities. The 3-year cumulative incidence of appropriate ICD therapy was similar in the DM and non-DM groups (12 and 13%, respectively, p = 0.983). Multivariate analysis showed that DM did not affect the risk of appropriate ICD therapy (HR = 1.07, 95% CI 0.78-1.47, p = 0.694) or inappropriate therapy (HR = 0.72, 95% CI 0.42-1.23, p = 0.232). However, DM was associated with a 31% increased risk for death or cardiac hospitalization (p = 0.005). Results were similar in subgroup analyses including ICD and defibrillators with cardiac resynchronization therapy function recipients, primary or secondary prevention indication for an ICD. Conclusions:Despite a significant excess of cardiac hospitalizations and mortality in the diabetic population, there was no difference in the rate of ICD treatments, suggesting that the outcome difference is not related to arrhythmias.

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Influence of Diabetes Mellitus on Inappropriate and Appropriate Implantable Cardioverter-Defibrillator Therapy and Mortality in the Multicenter Automatic Defibrillator Implantation Trial–Reduce Inappropriate Therapy (MADIT-RIT) Trial

Cited by 25 publications

References 41 publications

Early Experience with the Subcutaneous ICD

Early Experience with the Subcutaneous ICD

Incidence, Predictors, and Outcomes of Implantable Cardioverter‐Defibrillator Discharge Among People Living With HIV

176-54: Characteristics and Outcomes of Diabetic Patients with an Implantable Cardioverter Defibrillator in a Real World Setting: Results From the Israeli ICD Registry

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