title: Smoking is associated with an increased risk of first and recurrent ventricular tachyarrhythmias in ischemic and nonischemic patients with mild heart failure: a MADIT-CRT substudy.
abstract: BACKGROUND
  Limited data exist regarding the proarrhythmic effects of smoking.
  
  
  OBJECTIVE
  To evaluate the relationship between smoking and the risk of first and recurrent ventricular tachyarrhythmias (VTAs) in patients with mild heart failure.
  
  
  METHODS
  The risk of a first and recurrent appropriate implantable cardioverter-defibrillator therapy for VTAs or death was compared between nonsmokers (n = 465), past smokers (n = 780), and current smokers (n = 197) in patients with ischemic and nonischemic cardiomyopathy who were enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy study.
  
  
  RESULTS
  The cumulative probability of a first VTA or death was significantly higher in current smokers than in past and nonsmokers (P < .001). Multivariate analysis showed that current smokers had a significantly higher risk of first ventricular tachycardia/ventricular fibrillation or death (hazard ratio [HR] 1.51; 95% confidence interval [CI] 1.14-2.01; P = .005) and a higher risk for first ventricular tachycardia/ventricular fibrillation episode (HR 1.54, 95% CI 1.12-2.13, P = .008) than did nonsmokers. Past smokers had a risk of first VTAs or death similar to that of nonsmokers (HR 1.01; 95% CI 0.80-1.27; P = .953). In comparison to nonsmokers, the risk of recurrent VTAs was significantly higher in the total cohort of patients (HR 1.54; 95% CI 1.21-1.95; P < .001) and in the subgroups of patients with ischemic and nonischemic cardiomyopathy (HR 1.48; 95% CI 1.03-2.13; P = .035).
  
  
  CONCLUSIONS
  Current smokers with left ventricular dysfunction and mild heart failure are at a significantly higher risk of VTAs or death than are past smokers and nonsmokers. Smoking is associated with a significant increase in the risk of recurrent VTAs in both patients with ischemic and nonischemic cardiomyopathy.
authors: University of Rochester Medical Center, Rochester, New York.
authors: Benjamin
authors: B
authors: Plank
authors: University of Rochester Medical Center, Rochester, New York.
authors: Valentina
authors: V
authors: Kutyifa
authors: University of Rochester Medical Center, Rochester, New York.
authors: Arthur J
authors: AJ
authors: Moss
authors: University of Rochester Medical Center, Rochester, New York.
authors: David T
authors: DT
authors: Huang
authors: University of Rochester Medical Center, Rochester, New York.
authors: Anne-Christine H
authors: AC
authors: Ruwald
authors: University of Rochester Medical Center, Rochester, New York.
authors: Scott
authors: S
authors: McNitt
authors: University of Rochester Medical Center, Rochester, New York.
authors: Bronislava
authors: B
authors: Polonsky
authors: University of Rochester Medical Center, Rochester, New York.
authors: Wojciech
authors: W
authors: Zareba
authors: University of Rochester Medical Center, Rochester, New York.
authors: Ilan
authors: I
authors: Goldenberg
authors: University of Rochester Medical Center, Rochester, New York. Electronic address: Mehmet_Aktas@urmc.rochester.edu.
authors: Mehmet K
authors: MK
authors: Aktas
mesh_terms: D000368:Aged; D002170:Canada / Q000453:epidemiology; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D005060:Europe / Q000453:epidemiology; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology
keywords: Implantable cardioverter-defibrillator; Smoking; Ventricular fibrillation; Ventricular tachycardia