title: Prediction of Appropriate Shocks Using 24-Hour Holter Variables and T-Wave Alternans After First Implantable Cardioverter-Defibrillator Implantation in Patients With Ischemic or Nonischemic Cardiomyopathy.
abstract: In patients treated with implantable cardioverter defibrillator (ICD), prediction of both overall survival and occurrence of shocks is important if improved patient selection is desired. We prospectively studied the predictive value of biomarkers and indexes of cardiac and renal function and spectral microvolt T-wave alternans testing and 24-hour Holter variables in a population who underwent first ICD implantation. Consecutive patients in sinus rhythm with ischemic or dilated cardiomyopathy scheduled for primary or secondary prophylactic ICD implantation were enrolled. Exercise microvolt T-wave alternans and 24-hour Holter for number of ventricular premature contractions (VPCs), deceleration capacity, heart rate variability, and heart rate turbulence were done. Death of any cause and first appropriate ICD shock were defined as end points. Over 33 ± 15 months of follow-up, 36 of 253 patients (14%) received appropriate shocks and 39 of 253 patients (15%) died. Only 3 of 253 patients (1%) died after receiving at least 1 appropriate shock. In univariate analyses, New York Heart Association class, ejection fraction, N-terminal pro brain-type natriuretic peptide (NT-proBNP), renal function, ICD indication, deceleration capacity, heart rate variability, and heart rate turbulence were predictive of all-cause mortality and VPC number and deceleration capacity predicted first appropriate shock. NT-proBNP (≥1,600 pg/ml) was identified as the only independent predictor of all-cause mortality (hazard ratio 3.0, confidence interval 1.3 to 7.3, p = 0.014). In contrast, VPC number predicted appropriate shocks (hazard ratio 2.3, confidence interval 1.0 to 5.5, p = 0.047) as the only independent risk marker. In conclusion, NT-proBNP is a strong independent predictor of mortality in a typical prospective cohort of newly implanted patients with ICD, among many electrocardiographic and clinical variables studied. Number of VPCs was identified as a predictor of appropriate shocks (clinicaltrials.gov: NCT02010515).
authors.affiliation: Clinical Electrophysiology Division, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany; Division of Cardiology, Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Seegers
authors.affiliation: Clinical Electrophysiology Division, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.
authors.forename: Leonard
authors.initials: L
authors.lastname: Bergau
authors.affiliation: Clinical Electrophysiology Division, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.
authors.forename: Pascal Muñoz
authors.initials: PM
authors.lastname: Expósito
authors.affiliation: Division of Cardiology, Department of Internal Medicine I, Munich University Clinic, Ludwig-Maximilian University, Munich, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Bauer
authors.affiliation: Clinical Electrophysiology Division, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Fischer
authors.affiliation: Clinical Electrophysiology Division, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Lüthje
authors.affiliation: Clinical Electrophysiology Division, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuß
authors.affiliation: DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany; Department of Medical Statistics, University Medical Centre Göttingen, Göttingen, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Friede
authors.affiliation: Clinical Electrophysiology Division, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany. Electronic address: markus.zabel@med.uni-goettingen.de.
authors.forename: Markus
authors.initials: M
authors.lastname: Zabel
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D017147:Defibrillators, Implantable; D018572:Disease-Free Survival; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain