Predictors of VT/VF-occurrence in ICD patients: results from the PROFIT-Study.
OBJECTIVE
Identification of risk factors for ventricular tachycardia/ventricular fibrillation (VT/VF) occurrence in patients with implantable cardioverter-defibrillators (ICD) is reasonable, because ICD patients with multiple risk factors might benefit from more aggressive anti-arrhythmic therapy for the prevention of arrhythmic events. Furthermore, in the era of prophylactic ICD therapy and limited healthcare resources, additional markers are needed for improved patient selection.


RESULTS
Thus, in Prospective Analysis of Risk Factor for Appropriate ICD Therapy (PROFIT), we prospectively analyzed the role of ejection fraction (EF), N-terminal probrain natriuretic peptide (NT-proBNP), New York Heart Association (NYHA) class, atrial fibrillation, and QRS-duration as independent predictors for VT/VF occurrence in 250 ICD patients. Kaplan-Meier analysis showed that EF<40% (log-rank P=0.001), NT-proBNP levels higher than median (>or=405 ng/L; log-rank P=0.04), QRS-duration >or=150 ms (log-rank P=0.016), permanent atrial fibrillation (log-rank P=0.008), and higher NYHA class (log-rank P=0.029) were associated with VT/VF occurrence. By multivariate Cox regression analysis EF, QRS-duration and atrial fibrillation remained significantly associated with appropriate VT/VF therapy, whereas there was no relationship among NT-proBNP, NYHA class, and VT/VF occurrence. Stratifying patients according to the number of their independent risk factors (EF<40%, AF, QRS-width>or=150 ms) showed that patients with greater than or equal to two risk factors had a 100% 2-year risk of VT/VF occurrence, whereas patients with no or one risk factor had a 19.3 and 25% 2-year risk, respectively.


CONCLUSIONS
EF<40%, permanent atrial fibrillation, and QRS>or=150 ms are independent predictors for VT/VF occurrence in predominantly secondary prophylactic ICD patients. Combining all independent predictors, we developed a risk score for VT/VF occurrence identifying a subgroup of patients with two or more risk factors who had a 100% 2-year risk. Future studies will reveal if this risk score helps to identify ICD patients suitable for empirical anti-arrhythmic therapy and to improve patient selection for prophylactic ICD therapy.
Klein
Gunnar
G
Department of Cardiovascular Medicine, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. gunnarklein@yahoo.de
Lissel
Christoph
C
Fuchs
Anne-Catherine
AC
Gardiwal
Ajmal
A
Oswald
Hanno
H
Desousa
Marcos
M
Pichlmaier
A Maximilian
AM
Lichtinghagen
Ralf
R
Geerlings
Heinz
H
Lippolt
Peter
P
Niehaus
Michael
M
Drexler
Helmut
H
Korte
Thomas
T
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000503:physiopathology; D015331:Cohort Studies; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000502:physiology; D018579:Patient Selection; D010446:Peptide Fragments / Q000502:physiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D017180:Tachycardia, Ventricular / Q000145:classification / Q000209:etiology* / Q000503:physiopathology* / Q000517:prevention & control; D014693:Ventricular Fibrillation / Q000145:classification / Q000209:etiology* / Q000503:physiopathology* / Q000517:prevention & control
D000889:Anti-Arrhythmia Agents; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain