Mortality Risk Increases With Clustered Ventricular Arrhythmias in Patients With Implantable Cardioverter-Defibrillators

Elsokkari, Ihab; Parkash, Ratika; Tang, Anthony; Wells, George A.; Doucette, Steve; Yetisir, Elizabeth; Gardner, Martin J.; Healey, Jeffrey S.; Thibault, Bernard; Sterns, Laurence D.; Birnie, David H.; Nery, Pablo B.; Sivakumaran, Soori; Essebag, Vidal; Dorian, Paul; Sapp, John L.

doi:10.1016/j.jacep.2019.11.012

Cited by 21 publications

(20 citation statements)

References 22 publications

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“…Significant adverse prognostic association of clustered VTAs is observable with even 2 VTA events within 3 months and increases with higher cluster density ( 25 ). An association between ES and an increase in monthly temperature variation had been reported ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Effects of Apparent Temperature on the Incidence of Ventricular Tachyarrhythmias in Patients With an Implantable Cardioverter–Defibrillator: Differential Association Between Patients With and Without Electrical Storm

et al. 2021

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Background: Electrical storm (ES) has profound psychological effects and is associated with a higher mortality in patients with implantable cardioverter–defibrillator (ICD). Assessing the incidence and features of ES, is vital. Previous studies have shown winter peaks for ventricular tachyarrhythmia (VTA) in ICD patients. However, the effects of heat with a high relative humidity remain unclear. Thus, this study aimed to assess the nonlinear and lagged effects of apparent temperature [or heat index (HI)] on VTA among patients with and without ES after ICD implantation.Methods: Of 626 consecutive patients who had ICDs implanted from January 2004 to June 2017 at our hospital, 172 who experienced sustained VTAs in ICD recording were analyzed, and their clinical records were abstracted to assess the association between VTA incidence and HI by time-stratified case-crossover analysis. Cubic splines were used for the nonlinear effect of HI, with adjustment for air pollutant concentrations.Results: A significant seasonal effect for ES patients was noted. Apparent temperature, but not ambient temperature, was associated with VTA occurrences. The low and high HI thresholds for VTA incidence were <15° and >30°C, respectively, with a percentage change in odds ratios of 1.06 and 0.37, respectively, per 1°C. Lagged effects could only be demonstrated in ES patients, which lasted longer for low HI (in the next 4 days) than high HI (in the next 1 day).Conclusion: VTA occurrence in ICD patients was strongly associated with low HI and moderately associated with high HI. Lagged effects of HI on VTA were noted in patients with ES. Furthermore, patients with ES were more vulnerable to heat stress than those without ES. Patients with ICD implantation, particularly in those with ES, should avoid exposure to low and high HI to reduce the risk of VTAs, improve quality of life and possibly reduce mortality.

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Section: Discussionmentioning

confidence: 99%

Effects of Apparent Temperature on the Incidence of Ventricular Tachyarrhythmias in Patients With an Implantable Cardioverter–Defibrillator: Differential Association Between Patients With and Without Electrical Storm

et al. 2021

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“…45 Elsokkari et al was the only study to evaluate the dose-response relationship between VT burden and mortality using the density of clustering of episodes of ventricular arrhythmias for VT burden. 49 All arrhythmia episodes from the Resynchronization in Ambulatory Heart Failure Trial (RAFT) were subjected to blinded adjudication and were used for the study. RAFT included patients with NYHA II or III HF despite optimal medical therapy with a prolonged QRS duration, an LVEF 30%, and a primary or secondary prevention indication for ICD.…”

Section: 09)]mentioning

confidence: 99%

“…VT burden was assessed as cluster burden and cluster length. 49 Cluster burden was number of ventricular arrhythmia events and cluster length was the duration of time during which ventricular arrhythmia events occurred. 49 Almost 50% of patients in RAFT (871 of 1764 patients; 49.4%) had a ventricular arrhythmia during the follow-up period of a median of 40.1 (IQR 24.6-55.9) months.…”

Section: 09)]mentioning

confidence: 99%

“…49 Cluster burden was number of ventricular arrhythmia events and cluster length was the duration of time during which ventricular arrhythmia events occurred. 49 Almost 50% of patients in RAFT (871 of 1764 patients; 49.4%) had a ventricular arrhythmia during the follow-up period of a median of 40.1 (IQR 24.6-55.9) months. In general, the risk of mortality incrementally increased with the number of ES episodes within each strata of time.…”

Section: 09)]mentioning

confidence: 99%

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Ventricular Tachycardia Burden and Mortality: Association or Causality?

Samuel¹,

Elsokkari²,

Sapp³

2022

Canadian Journal of Cardiology

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“…They reported that a shorter period of time and a large number of therapies led to a further increase in the mortality rate. 19 In a meta-analysis of RM of ICD, an analysis of three trials that targeted Biotronik SE & Co. KG (Berlin, Germany) that automatically receives and sends data every day confirmed a significant decrease in mortality rate. However, an analysis of four trials that used CareLink (Medtronic, Inc., Tempe, Arizona) did not confirm a decrease in the mortality rate.…”

Section: Appropriate Therapy Reduction In Es By Atp-alertmentioning

confidence: 99%

Efficacy of antitachycardia pacing alert by remote monitoring of implantable cardioverter‐defibrillators for out‐of‐hospital electrical storm

Otsuki

Izumi

Sakaguchi

et al. 2021

Pacing Clinical Electrophis

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Background: Remote monitoring (RM) has been shown to reduce all-cause mortality in patients with implantable cardioverter-defibrillators or cardiac resynchronization therapy defibrillators (ICD/CRT-D). Not all devices transmit an alert for antitachycardia pacing (ATP) therapy, and it is unknown whether differences of RM alert affect the outcomes of electrical storm (ES). Methods:We enrolled 42 patients with ICD/CRT-D whose out-of-hospital ES were detected by RM between 2013 and 2020. We divided their 54 episodes into two groups (ATP-alert-on; 22, ATP-alert-off; 32), and clinical outcomes were compared between the two groups.Results: In 35 of 54 episodes of ES, ventricular tachycardia (VT) could be terminated within 24 h of ES onset just by ATP (ATP-alert-on: 14, ATP-alert-off: 21); however, many patients subsequently received shock delivery for VT. Among the 35 episodes, only in ATP-alert-on group, seven patients were prompted to visit our hospital without ICD shock through confirmation of ES by ATP-alert. Episodes that led to shock delivery 24 h or longer after the ES onset were significantly less common in the ATP-alert-on group (ATP-alert-on: 1/14, ATP-alert-off: 9/21, p = .03). Although there were no significant differences in the number of shock deliveries between episodes in the two groups, the number of ATP deliveries were significantly fewer in the ATP-alert-on group (12[7-26] vs. 29 in ATP-alert-off group, p = .03). Multivariate logistic regression analyses showed that the only ATP-alert significantly reduced ATP deliveries (HR = 0.14, 95%CI = 0.04-0.57, p = .003). Conclusion:Remote monitoring with an ATP-alert function during electrical storm may reduce appropriate ICD therapy through prompting early review.

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Mortality Risk Increases With Clustered Ventricular Arrhythmias in Patients With Implantable Cardioverter-Defibrillators

Cited by 21 publications

References 22 publications

Effects of Apparent Temperature on the Incidence of Ventricular Tachyarrhythmias in Patients With an Implantable Cardioverter–Defibrillator: Differential Association Between Patients With and Without Electrical Storm

Effects of Apparent Temperature on the Incidence of Ventricular Tachyarrhythmias in Patients With an Implantable Cardioverter–Defibrillator: Differential Association Between Patients With and Without Electrical Storm

Ventricular Tachycardia Burden and Mortality: Association or Causality?

Efficacy of antitachycardia pacing alert by remote monitoring of implantable cardioverter‐defibrillators for out‐of‐hospital electrical storm

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