title: Ventricular Arrhythmia Burden in Patients With Heart Failure and Cardiac Resynchronization Devices: The Importance of Renal Function.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is a risk factor for arrhythmias in patients with heart failure (HF). However, the effects of CKD on ventricular arrhythmia (VA) burden in patients with cardiac resynchronization therapy and defibrillator (CRT-D) devices in a primary prevention setting are unknown.
  
  
  OBJECTIVE
  To determine whether baseline CKD is associated with increased risk of VA in patients implanted with primary prevention CRT-D devices.
  
  
  RESULTS
  In this retrospective study, 199 consecutive primary prevention CRT-D recipients (2005-2010) were stratified by estimated glomerular filtration rate (eGFR) levels prior to device implantation with 106 (53.2%) ≥CKD III (eGFR < 60 mL/min/1.73 m2) (CKD group). CKD group patients were significantly older (70.0 ± 10 years vs. 61.3 ± 12 years, P < 0.05) with higher prevalence of ischemic cardiomyopathy (56.2% vs. 40.2%, P < 0.05). Detected ventricular tachycardia (VT)/ventricular fibrillation (VF) episodes resulting in device therapy occurred significantly more frequently in the CKD group [40/106(37.8%)] than controls [24/93(25.8%)], (odd ratio [OR] = 1.74, 95% confidence interval [CI] = 1.01-3.2, P = 0.05). At 5-year follow-up, interval censored data analysis showed 41% VT/VF incidence in the CKD group compared to 24% incidence in controls (P < 0.05). Cox proportional hazards model identified CKD > III as the only predictor of sustained VA in this group (adjusted hazard ratio [HR] 2.92, CI = 1.39-6.1, P = 0.004).
  
  
  CONCLUSIONS
  Baseline CKD is a strong independent risk factor for VA in primary prevention CRT-D recipients. Further understanding of the underlying arrhythmogenic mechanisms relating to CKD may be of interest to allow appropriate correction and prevention. Device programming in this cohort may need to reflect this increased risk.
authors: Barts Heart Centre, St. Bartholomew, s Hospital, London, UK.
authors: Girish
authors: G
authors: Ganesha Babu
authors: Royal Free Hospital, London, UK.
authors: Matthew
authors: M
authors: Webber
authors: Barts Heart Centre, St. Bartholomew, s Hospital, London, UK.
authors: Rui
authors: R
authors: Providencia
authors: Biomedical Sciences/Regenerative Medicine, David Geffen School of Medicine, UCLA, Cedars Sinai Medical Center, Los Angeles, California, USA.
authors: Sanjeev
authors: S
authors: Kumar
authors: Barts Heart Centre, St. Bartholomew, s Hospital, London, UK.
authors: Aerakondal
authors: A
authors: Gopalamurugan
authors: Northern General Hospital, Sheffield, UK.
authors: Dominic P
authors: DP
authors: Rogers
authors: Barts Heart Centre, St. Bartholomew, s Hospital, London, UK.
authors: Holly Louise
authors: HL
authors: Daw
authors: Barts Heart Centre, St. Bartholomew, s Hospital, London, UK.
authors: Syed
authors: S
authors: Ahsan
authors: Barts Heart Centre, St. Bartholomew, s Hospital, London, UK.
authors: Fakhar
authors: F
authors: Khan
authors: Barts Heart Centre, St. Bartholomew, s Hospital, London, UK.
authors: Anthony
authors: A
authors: Chow
authors: Barts Heart Centre, St. Bartholomew, s Hospital, London, UK.
authors: Martin
authors: M
authors: Lowe
authors: Barts Heart Centre, St. Bartholomew, s Hospital, London, UK.
authors: Edward
authors: E
authors: Rowland
authors: Barts Heart Centre, St. Bartholomew, s Hospital, London, UK.
authors: Pier
authors: P
authors: Lambiase
authors: Barts Heart Centre, St. Bartholomew, s Hospital, London, UK.
authors: Oliver R
authors: OR
authors: Segal
keywords: cardiac resynchronization therapy; chronic kidney disease; heart failure; implantable cardioverter defibrillator; renal failure