title: [The evaluation of the ventricular arrhythmias and interventions of cardiac implantable electronic devices in patients with dilated cardiomyopathy for primary prevention of sudden cardiac death in ambulatory and telemetric follow-up].
abstract: Telemetric follow-up (RM) after cardiac devices implantation is not inferior to classic follow-up and enables earlier clinical complications detection.
  
  
  OBJECTIVE
  The aim of the study was to evaluation of the ventricular arrhythmias and interventions of ICD/CRTD in ambulatory and telemetric follow-up in patients with dilated cardiomyopathy.
  
  
  METHODS
  Group A (CRT-D+ICD) - retrospective, patients followed-up in outpatient clinic - was consisted with 273 patients (mean age 65±11 years, 230M). In group A 128 patients after CRT-D implantation and 145 patients with ICD were selected. Group B (RM group) - prospective, RM Medtronic Carelink followup - was consisted with 177 patients (mean age 61±13 years, 141M). 35 patients had CRT-D and 142 had ICD implanted. Follow-up of patients from group A was performed in outpatient clinic. Follow-up of patients from group B was monitored daily follow-up using RM system (Medtronic Carelink). Frequency/type of ventricular arrhythmias, device interventions, patient's clinical status, medications, were assessed in both groups. To assess presence of ventricular arrhythmias, device interventions, ICD and CRT-D programming changes, pharmacotherapy changes, patients were randomly chosen from group A, according to age, gender, LVEF value, NYHA class, comorbidities, time of follow-up as a control group to group B (RM group).
  
  
  RESULTS
  In multivariate analysis, it was found that a low ejection fraction <25% (HR 0,929; p<0,001), and diabetes mellitus (HR 7,038; p<0,009) predispose to ventricular arrhythmias. In the RM group, compared to control group, there were significantly less programming changes (5,9 vs 47,1%, p<0,001), time to first events (ventricular arrhythmias - 258 vs 487 d, p<0,001; interventions - 295 vs 775 d, p<0,01) was shorter, while time to first necessary programming (364 vs 304 d, p<0,001) or pharmacotherapy (330 vs 244 days, p<0,001) change was longer. General mortality did not differ significantly between the groups (p=0,130).
  
  
  CONCLUSIONS
  Low ejection fraction <25%, and diabetes mellitus predispose to ventricular arrhythmias. Telemetric follow-up of cardiac implantable devices enables quick information transmission in cases of clinical complications (arrhythmias, interventions) and reduces number of ambulatory visits to only necessary ones. Telemetric followup of cardiac implantable devices is a safe. Key words: ventricular arrhythmias, interventions.
authors.affiliation: Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków.
authors.forename: Jacek
authors.initials: J
authors.lastname: Lelakowski
authors.affiliation: Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków.
authors.forename: Anna
authors.initials: A
authors.lastname: Rydlewska
authors.affiliation: Department of Coronary Disease and Heart Failure, The John Paul II Hospital in Kraków.
authors.forename: Maria
authors.initials: M
authors.lastname: Lelakowska
authors.affiliation: Jagiellonian University, Institute of Cardiology, Department of Electrocardiology, The John Paul II Hospital in Kraków.
authors.forename: Joanna
authors.initials: J
authors.lastname: Pudło
authors.affiliation: Department of Electrocardiology, The John Paul II Hospital in Kraków.
authors.forename: Justyna
authors.initials: J
authors.lastname: Piekarz
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000628:therapy*; D002311:Cardiomyopathy, Dilated / Q000150:complications*; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D017147:Defibrillators, Implantable; D005260:Female; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland; D011322:Primary Prevention; D013686:Telemetry; D016896:Treatment Outcome
keywords: CRTD; ICD; interventions; telemetric followup; traditional follow-up in outpatient clinic; ventricular arrhythmias