Primary Prevention of Sudden Death in Patients With Valvular Cardiomyopathy.
OBJECTIVE
Few data exist on the outcomes of valvular cardiomyopathy patients referred for defibrillator implantation for primary prevention. The aim of the present study was to describe the outcomes of this cardiomyopathy subgroup.


METHODS
This multicenter retrospective study included consecutive patients referred for defibrillator implantation to 15 Spanish centers in 2010 and 2011, and to 3 centers after 1 January 2008.


RESULTS
Of 1174 patients, 73 (6.2%) had valvular cardiomyopathy. These patients had worse functional class, wider QRS, and a history of atrial fibrillation vs patients with ischemic (n=659; 56.1%) or dilated (n=442; 37.6%) cardiomyopathy. During a follow-up of 38.1 ± 21.3 months, 197 patients (16.7%) died, without significant differences among the groups (19.2% in the valvular cardiomyopathy group, 15.8% in the ischemic cardiomyopathy group, and 17.9% in the dilated cardiomyopathy group; P=.2); 136 died of cardiovascular causes (11.6%), without significant differences among the groups (12.3%, 10.5%, and 13.1%, respectively; P=.1). Although there were no differences in the proportion of appropriate defibrillator interventions (13.7%, 17.9%, and 18.8%; P=.4), there was a difference in inappropriate interventions (8.2%, 7.1%, and 12.0%, respectively; P=.03).


CONCLUSIONS
All-cause and cardiovascular mortality in patients with valvular cardiomyopathy were similar to those in other patients referred for defibrillator implantation. They also had similar rates of appropriate interventions. These data suggest that defibrillator implantation in this patient group confers a similar benefit to that obtained by patients with ischemic or dilated cardiomyopathy.
Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain. Electronic address: moirmanero@gmail.com.
Moisés
M
Rodríguez-Mañero
Unidad de Arritmias, Servicio de Cardiología, Hospital Virgen de las Nieves, Granada, Spain.
María Teresa
MT
Barrio-López
Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
Emad Abu
EA
Assi
Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain.
Víctor
V
Expósito-García
Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario de San Juan, Sant Joan d'Alacant, Alicante, Spain.
Vicente
V
Bertomeu-González
Unidad de Arritmias, Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia, Spain.
Juan Miguel
JM
Sánchez-Gómez
Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen Macarena, Seville, Spain.
Luis
L
González-Torres
Unidad de Arritmias, Servicio de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain.
Ignacio
I
García-Bolao
Unidad de Arritmias, Servicio de Cardiología, Hospital de Basurto, Bilbao, Vizcaya, Spain.
Larraitz
L
Gaztañaga
Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario de Vigo, Vigo, Pontevedra, Spain.
Pilar
P
Cabanas-Grandío
Unidad de Arritmias, Servicio de Cardiología, Hospital Fundación Jiménez Díaz, Madrid, Spain.
José Antonio
JA
Iglesias-Bravo
Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain.
Álvaro
Á
Arce-León
Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Ana Andrés
AA
la Huerta
Unidad de Arritmias, Servicio de Cardiología, Hospital Puerta del Mar, Cádiz, Spain.
Juan
J
Fernández-Armenta
Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
Rafael
R
Peinado
Unidad de Arritmias, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain.
Miguel Angel
MA
Arias
Unidad de Arritmias, Servicio de Cardiología, Hospital Universitario Virgen Macarena, Seville, Spain.
Ernesto
E
Díaz-Infante
D000368:Aged; D009202:Cardiomyopathies / Q000150:complications / Q000628:therapy; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000628:therapy*; D016022:Case-Control Studies; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000628:therapy*; D011322:Primary Prevention; D016016:Proportional Hazards Models; D019919:Prosthesis Implantation; D012189:Retrospective Studies
Appropriate interventions; Desfibrilador automático implantable; Implantable cardioverter-defibrillator; Inappropriate interventions; Intervenciones apropiadas; Intervenciones inapropiadas; Miocardiopatía valvular; Prevención primaria de muerte súbita cardiaca; Primary prevention of sudden cardiac death; Valvular cardiomyopathy