Intracoronary administration of bone marrow-derived mononuclear cells and arrhythmic events in patients with chronic heart failure.
OBJECTIVE
There are continued debates on potential proarrhythmic effects of intracoronary bone marrow-derived progenitor cell (BMC) therapy for treatment of chronic heart failure. Implantable cardioverter-defibrillators (ICDs), a mainstay of heart failure therapy, provide the possibility of validly assessing arrhythmias in patients with chronic heart failure. The aim of this analysis was to assess the arrhythmogenic potential of intracoronary BMC therapy, continuously documented by ICD-stored intracardiac electrograms.


RESULTS
Matched cohort study of 112 patients receiving intracoronary administration of autologous BMC and 224 heart failure patients, matched for age, gender, and left ventricular ejection fraction fitted with an ICD. Within a follow-up period of 2 years (total patient-years at risk: 595 years), no significant difference was detected for ICD-stored episodes of ventricular tachycardia (VT; 25.0 vs. 27.1%; P = 0.779), VT/ventricular fibrillation treated by antitachycardia pacing or ICD shock (15.6 vs. 15.5%; P = 0.956), or death from arrhythmic cause (4.2 vs. 1.0%; P = 0.667). Predictors of occurrence of major arrhythmic events were parameters of advanced heart failure and implantation of ICD for secondary prevention; no influence could be detected for BMC administration (odds ratio = 1.198; P = 0.440).


CONCLUSIONS
There is no evidence that intracoronary administration of BMC aggravates life-threatening arrhythmias in patients with chronic heart failure.
Department of Medicine III - Cardiology and Molecular Cardiology, Goethe - University of Frankfurt, Frankfurt/Main D-60590, Germany. aschober@ukaachen.de
David M
DM
Leistner
Jörn
J
Schmitt
Sylvia
S
Palm
Jens
J
Klotsche
Stephanie
S
Estel
Agnes
A
Fink
Carsten W
CW
Israel
Birgit
B
Assmus
Gabor Z
GZ
Duray
Stefanie
S
Dimmeler
Stefan H
SH
Hohnloser
Andreas M
AM
Zeiher
D000368:Aged; D016022:Case-Control Studies; D002908:Chronic Disease; D016757:Death, Sudden, Cardiac / Q000209:etiology; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000637:transplantation*; D033581:Stem Cell Transplantation / Q000379:methods*; D017180:Tachycardia, Ventricular / Q000209:etiology*; D014182:Transplantation, Autologous; D014693:Ventricular Fibrillation / Q000209:etiology*