title: Differences in predictors of implantable cardioverter-defibrillator therapies in patients with ischaemic and non-ischaemic cardiomyopathies.
abstract: OBJECTIVE
  Implantable cardioverter-defibrillators (ICDs) have been shown to reduce mortality in patients with both ischaemic and non-ischaemic cardiomyopathy by terminating life-threatening arrhythmias. However, such arrhythmic events are unequally distributed among different patient subgroups. We aimed to evaluate predictors of appropriate ICD therapies as a step towards risk stratification in a real-world cohort.
  
  
  RESULTS
  The prevalence and predictors of appropriate ICD therapies were analysed in 330 consecutive patients (mean age 65 ± 11, 81% male) with implanted ICDs due to ischaemic (n = 204) or dilated (n = 126) cardiomyopathy. During a mean follow-up of 19 ± 9 months, 1545 appropriate ICD therapies (antitachycardia pacing and shocks) were detected in 94 patients (29%). In multivariate analysis applied on the whole cohort, the presence of atrial fibrillation [AF: odds ratio (OR) = 1.906, confidence interval (CI) = 1.143-3.177, P = 0.013] and secondary prevention indication (OR = 1.963, CI = 1.123-3.432, P = 0.018) was associated with ICD therapy. The presence of cardiac resynchronization therapy (CRT) had a protective value (OR = 0.563, CI = 0.327-0.968, P = 0.038). Moreover, the predictors were different depending on the aetiology of the cardiomyopathy: in the ischaemic group, only secondary prevention indication (OR = 2.0, CI = 1.029-3.891, P = 0.041) and the presence of a biventricular system (OR = 0.359, CI = 0.163-0.794, P = 0.011) remained significant, while in the non-ischaemic group, an association with AF was observed (OR = 4.281, CI = 1.632-11.231, P = 0.003).
  
  
  CONCLUSIONS
  The aetiology of cardiomyopathy should be taken into consideration for the therapy of ICD patients. The protective role of CRT devices should be pointed out in ischaemic cardiomyopathy (ICM) and a more rigorous antiarrhythmic treatment should be considered for ICM patients with secondary prevention or for dilated cardiomyopathy patients with AF.
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Darma
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany snedios@gmail.com.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Nedios
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Jedrzej
authors.initials: J
authors.lastname: Kosiuk
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Sergio
authors.initials: S
authors.lastname: Richter
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Doering
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Arash
authors.initials: A
authors.lastname: Arya
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Rolf
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Sommer
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hindricks
authors.affiliation: Department of Electrophysiology, Heart Center, University of Leipzig, Strümpellstr. 39, Leipzig 04289, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Bollmann
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D009202:Cardiomyopathies / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002311:Cardiomyopathy, Dilated / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D017147:Defibrillators, Implantable; D018572:Disease-Free Survival; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D016017:Odds Ratio; D065840:Protective Factors; D012042:Registries; D012307:Risk Factors; D055502:Secondary Prevention / Q000295:instrumentation*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Antitachycardia pacing; Cardiomyopathy; ICD; Predictors; Shocks