Ventricular arrhythmias in patients with newly diagnosed nonischemic cardiomyopathy: Insights from the PROLONG study.
BACKGROUND
Patients with nonischemic cardiomyopathy (NICM) reportedly have low incidence of appropriate shocks from wearable cardioverter-defibrillators (WCDs). A recent study questions the benefit from primary preventive implantation of implantable cardioverter-defibrillators in NICM. We therefore analyzed a subgroup of patients with NICM from the PROLONG study.


OBJECTIVE
Patients with newly diagnosed NICM show a risk for ventricular tachyarrhythmia.


METHODS
The PROLONG study included 167 patients with newly diagnosed heart failure and left ventricular ejection fraction (LVEF) ≤35% with a WCD. Patients with NICM were identified and included in this analysis.


RESULTS
117 patients presented with NICM. Sixty-five (55%) were male; mean age was 51 ± 15 years. Mean LVEF at diagnosis was 23% ± 7%. Mean follow-up was 11 ± 10 months. Mean WCD wear time was 101 ± 82 days; mean wear time per day was 21.4 ± 4.5 hours. Overall, 12 ventricular arrhythmias occurred in 10 (9%) patients (6 DCM, 4 PPCM). Nine appropriate WCD shocks for hemodynamically unstable ventricular tachycardia/fibrillation in 8 (7%) patients were observed. Two patients presented sustained hemodynamically stable ventricular tachycardia for >30 minutes detected by the WCD, but withheld WCD therapy.


CONCLUSIONS
Patients with newly diagnosed NICM and LVEF ≤35% show an elevated risk of ventricular tachycardia/fibrillation during initiation and optimization of heart failure therapy. To prevent sudden cardiac death, WCD should be considered in patients with newly diagnosed NICM with severely reduced LVEF.
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
David
http://orcid.org/0000-0003-2996-6338
D
Duncker
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Thorben
T
König
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Stephan
S
Hohmann
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Johann
J
Bauersachs
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Christian
C
Veltmann
D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016277:Ventricular Function, Left
Nonischemic Cardiomyopathy; Sudden Cardiac Death; Ventricular Arrhythmia; Wearable Cardioverter-Defibrillator