Effect of Significant Weight Change on Inappropriate Implantable Cardioverter-Defibrillator Therapy.
BACKGROUND
Weight loss has been associated with adverse outcomes among heart failure (HF) patients, including those receiving cardiac resynchronization therapy with defibrillator (CRT-D). The effect of significant weight change on inappropriate implantable cardioverter-defibrillator (ICD) therapy among CRT-D patients is not well understood.


METHODS
We evaluated the impact of significant weight change at 1 year on subsequent inappropriate ICD therapy during follow-up among 993 CRT-D patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy. Patients were divided into three subgroups based on weight change at 1 year after enrollment: weight loss (weight loss ≥ 5%), weight gain (weight gain ≥ 5%), and stable weight (weight loss and weight gain < 5%). The primary end point was inappropriate ICD therapy. Secondary end point included inappropriate ICD therapy related to supraventricular arrhythmias (SVAs).


RESULTS
There were 102 (10.3%) patients who experienced weight loss, 689 (69.4%) whose weight was stable, and 202 (20.3%) who gained weight at 1 year. Patients with weight loss had increased risk of subsequent inappropriate ICD therapy relative to patients with stable weight (hazard ratio [HR] = 2.35, 95% confidence interval [CI]: 1.39-3.98, P = 0.001) or weight gain (HR = 2.27, 95% CI: 1.18-4.38, P = 0.014). Furthermore, patients losing weight were at greater risk of subsequent inappropriate ICD therapy related to SVAs when compared to patients with stable weight (HR = 2.16, 95% CI: 1.18-3.95, P = 0.013) or weight gain (HR = 2.02, 95% CI: 0.95-4.29, P = 0.068).


CONCLUSIONS
In mild HF patients receiving CRT-D, significant weight loss at 1 year is associated with increased risk of subsequent inappropriate ICD therapy, including risk related to SVAs.
Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA.
Usama A
UA
Daimee
Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA.
Yitschak
Y
Biton
Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA.
Mehmet K
MK
Aktas
Department of Cardiology, Nancy University, Université de Lorraine, Nancy, France.
Faiez
F
Zannad
Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA.
Helmut
H
Klein
Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA.
Barbara
B
Szepietowska
Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA.
Scott
S
McNitt
Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA.
Bronislava
B
Polonsky
Cardiology Division, Stanford University School of Medicine, Palo Alto, California, USA.
Paul J
PJ
Wang
Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA.
Wojciech
W
Zareba
Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA.
Arthur J
AJ
Moss
Heart Research Follow-up Program, Division of Cardiology, University of Rochester Medical Center, Rochester, New York, USA.
Valentina
V
Kutyifa
D000368:Aged; D015984:Causality; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004556:Electric Injuries / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology*; D015995:Prevalence; D018570:Risk Assessment; D013851:Thinness / Q000453:epidemiology*; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
cardiac resynchronization therapy; inappropriate implantable cardioverter-defibrillator therapy; mild heart failure; supraventricular arrhythmias; weight change