Chronic total occlusion of an infarct-related artery: a new predictor of ventricular arrhythmias in primary prevention implantable cardioverter defibrillator patients.
The aim of this article is to evaluate the impact of a coronary chronic total occlusion in an infarct-related artery (IRA-CTO) on the occurrence of ventricular arrhythmias (VAs) in patients implanted with an implantable cardioverter defibrillator (ICD) for primary prevention.



The study includes a prospective cohort of 108 consecutive patients with ischaemic cardiomyopathy, in whom an ICD was implanted for primary prevention and a coronary angiography performed before ICD implantation. About 49 patients (45%) had a CTO and 34 (31%) had an IRA-CTO. Patients with IRA-CTO did not differ from the rest of the population in terms of basal characteristics and severity of cardiac disease. Median follow-up was 33 months (interquartile range 46). Infarct-related artery-CTO was associated with higher rates of any VA (53 vs. 26%, P = 0.006) and fast ventricular tachycardia (fast VT, cycle length <300 ms) or ventricular fibrillation (VF) (47 vs. 19%, P = 0.002). At multivariate Cox regression, IRA-CTO was the only independent predictor of any VA [hazard ratio (HR) 3.64, P = 0.002] and fast VT/VF (HR 3.36, P = 0.008). On the contrary, CTO not associated with a prior infarction in their territory did not increase the risk of VA. Infract-related artery-CTO was also an independent predictor of cardiac mortality or heart transplantation (HR 3.46, P = 0.022).



In ischaemic patients implanted with an ICD for primary prevention, a CTO associated with a previous infarction in its territory is an independent predictor of VA and, especially, of fast VT/VF, identifying a subgroup of patients with a very high rate of arrhythmic events at follow-up.
Arrhythmia Unit, Heart Diseases Institute, Bellvitge University Hospital, Calle feixa llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
Andrea
A
Di Marco
Arrhythmia Unit, Heart Diseases Institute, Bellvitge University Hospital, Calle feixa llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
Ignasi
I
Anguera
Interventional Cardiology Unit, Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain.
Luis
L
Teruel
Arrhythmia Unit, Heart Diseases Institute, Bellvitge University Hospital, Calle feixa llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
Paolo
P
Dallaglio
Heart Failure Unit, Bellvitge University Hospital, Barcelona, Spain.
José
J
González-Costello
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain.
Valentina
V
León
Arrhythmia Unit, Heart Diseases Institute, Bellvitge University Hospital, Calle feixa llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
Elaine
E
Nuñez
Heart Failure Unit, Bellvitge University Hospital, Barcelona, Spain.
Nicolás
N
Manito
Interventional Cardiology Unit, Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain.
Joan Antoni
JA
Gómez-Hospital
Arrhythmia Unit, Heart Diseases Institute, Bellvitge University Hospital, Calle feixa llarga s/n, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
Xavier
X
Sabaté
Heart Diseases Institute, Bellvitge University Hospital, Barcelona, Spain.
Ángel
Á
Cequier
D000368:Aged; D009202:Cardiomyopathies / Q000209:etiology / Q000628:therapy*; D002908:Chronic Disease; D015331:Cohort Studies; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000453:epidemiology*; D017147:Defibrillators, Implantable; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D017202:Myocardial Ischemia; D011322:Primary Prevention; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017180:Tachycardia, Ventricular / Q000453:epidemiology* / Q000517:prevention & control; D014693:Ventricular Fibrillation / Q000453:epidemiology* / Q000517:prevention & control