title: Incidence and prognostic significance of sustained ventricular tachycardias in heart failure patients implanted with biventricular pacemakers without a back-up defibrillator: results from the prospective, multicentre, Mona Lisa cohort study.
abstract: OBJECTIVE
  The aim of this study was to investigate the 12-month incidence, predictive factors, and prognosis of sustained ventricular tachycardia (VT) in chronic heart failure patients implanted with biventricular pacemakers without a back-up defibrillator (CRT-P), assessed by continuous intracardiac ventricular electrograms.
  
  
  RESULTS
  The Mona Lisa study, a prospective, multicentre, cohort study, designed to determine the incidence of sustained VT and its prognostic impact in CRT-P recipients within the year after implant enrolled 198 patients with moderate or severe chronic heart failure, despite optimal pharmacological therapy. An independent committee reviewed the data from all arrhythmic episodes as well as causes of death according to predefined criteria. During a mean follow-up of 9.8 +/- 3.1 months after implantation, 8 patients experienced at least one episode of sustained VT [4.3%; 95% confidence interval (CI), 1.1-7.5] and 21 deaths occurred, giving a 12-month mortality rate of 11.7% (95% CI, 6.4-16.9). The presence of sustained VT was associated with a high risk of sudden cardiac death (SCD) and the lowest 12-month overall survival (P < 0.0001).
  
  
  CONCLUSIONS
  The incidence of sustained VT remains relatively low in the first year after CRT-P implantation, but when present appears closely associated with short-term adverse outcomes, especially SCD. This emphasizes the possible value of remote monitoring to detect high-risk patients for urgent upgrading.
authors.affiliation: Clinique Pasteur, Département de Rythmologie, Toulouse, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Boveda
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.forename: Sophie
authors.initials: S
authors.lastname: Jacob
authors.forename: Pascal
authors.initials: P
authors.lastname: Defaye
authors.forename: Jobst B
authors.initials: JB
authors.lastname: Winter
authors.forename: Alan
authors.initials: A
authors.lastname: Bulava
authors.forename: Daniel
authors.initials: D
authors.lastname: Gras
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Albenque
authors.forename: Nicolas
authors.initials: N
authors.lastname: Combes
authors.forename: Dominique
authors.initials: D
authors.lastname: Pavin
authors.forename: Nicolas
authors.initials: N
authors.lastname: Delarche
authors.forename: Alexander
authors.initials: A
authors.lastname: Teubl
authors.forename: Marie
authors.initials: M
authors.lastname: Lambiez
authors.forename: Philippe
authors.initials: P
authors.lastname: Chevalier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D002423:Cause of Death; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011379:Prognosis; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality