title: Comparison of ventricular tachyarrhythmia characteristics in patients with idiopathic dilated or ischemic cardiomyopathy and defibrillators implanted for primary prevention.
abstract: BACKGROUND
  Implantable cardioverter-defibrillator (ICD) therapy for primary prevention is well established in ischemic cardiomyopathy (ICM). Data on the role of ICDs in patients with dilated cardiomyopathy (DCM) and no history of ventricular tachyarrhythmia (VT/VF) are more limited.
  
  
  OBJECTIVE
  DCM patients with an impaired left ventricular ejection fraction (LVEF) still represent a low arrhythmic risk subgroup in clinical practice.
  
  
  METHODS
  ICD stored data of DCM patients with an LVEF ≤35% was compared to data of ICM patients meeting Multicenter Automatic Defibrillator Implantation Trial (MADIT) eligibility criteria. VT/VF occurrences and electrical storm (ES) events were analyzed.
  
  
  RESULTS
  There were 652 patients followed for 50.9 ± 33.9 months. There were 1978 VT and 241 VF episodes analyzed in 66 out of 203 patients (32.5%) with DCM and in 118 out of 449 patients (26.3%, P = 0.209) with ICM. Freedom of appropriate ICD treatment due to VT/VF or ES events did not differ in both patient populations (log-rank, P>0.05). In patients presenting with VT/VF episodes, mean event rates were comparable in both patient populations (3.2 ± 14.1 for DCM and VT vs 3 ± 13.9 for ICM and VT [P = 0.855], 0.4 ± 1.3 for DCM and VF vs 0.4 ± 1.8 for ICM and VF [P = 0.763], and 0.2 ± 0.7 for DCM and ES vs 0.2 ± 1 for ICM and ES [P = 0.666]).
  
  
  CONCLUSIONS
  DCM patients with prophylactic ICDs implanted due to heart failure and patients fulfilling MADIT criteria reveal comparable patterns of VT/VF/ES events during long-term follow-up. Incidence, mean number of events, and time to first event did not differ significantly. Findings support the current guidelines for prophylactic ICD therapy in DCM patients with heart failure.
authors: First Department of Medicine-Cardiology, University Medical Centre and Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany. florian.streitner@umm.de
authors: Florian
authors: F
authors: Streitner
authors: Juergen
authors: J
authors: Kuschyk
authors: Claudia
authors: C
authors: Dietrich
authors: Eva
authors: E
authors: Mahl
authors: Ines
authors: I
authors: Streitner
authors: Christina
authors: C
authors: Doesch
authors: Christian
authors: C
authors: Veltmann
authors: Rainer
authors: R
authors: Schimpf
authors: Christian
authors: C
authors: Wolpert
authors: Martin
authors: M
authors: Borggrefe
mesh_terms: D000368:Aged; D009202:Cardiomyopathies / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation*; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011322:Primary Prevention / Q000295:instrumentation*; D011446:Prospective Studies; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016277:Ventricular Function, Left