Chronic kidney disease impairs prognosis in electrical storm

Journal of Interventional Cardiac Electrophysiology - The study sought to assess the prognostic impact of chronic kidney disease (CKD) in patients with electrical storm (ES). ES represents a...     

Prognostic impact of recurrences in patients with electrical storm

Objectives. The study sought to assess the prognostic impact of recurrences of electrical storm (ES-R) on mortality, rehospitalization and major adverse cardiac events (MACE). Background. Data on the prognostic impact of ES-R is rare. Methods. All consecutive ES patients with an implantable cardioverter defibrillator (ICD) were included retrospectively from 2002 to 2016. Patients with ES-R were compared to patients without ES-R. The primary endpoint was all-cause mortality, secondary endpoints were in-hospital mortality, rehospitalization and MACE. Results. A total of 87 consecutive ES patients with an ICD were included, of which 26% presented with ES-R at 2.5 years of follow-up. ES-R patients revealed lower LVEF compared to non-ES-R patients (91% vs. 61%; p?=?.081). There was a numerically higher rate of the primary endpoint of all-cause mortality at 2.5 years (50% vs. 32%; log-rank p?=?.137). Furthermore, ES-R was associated with increasing rates of rehospitalization (64% vs. 37%; p?=?.031; HR 1.985; 95% CI 1.025–3.845; log-rank p?=?.042), especially of acute heart failure (32% vs. 12%; p?=?.001; HR 3.262; 95% CI 1.180–9.023; log rank p?=?.023). MACE were higher in ES-R patients (55% vs. 35%; p?=?.113; log rank p?=?.141). ES patients with LVEF ≤35% were 12.4 times more likely to develop ES-R (HR 12.417; 95% CI 1.329–115.997; p?=?.027). Conclusion. At long-term follow-up of 2.5 years, ES-R was associated with numerically higher rates of long-term all-cause mortality and significantly higher rates of rehospitalization due to acute heart failure. LVEF ≤35% was associated with increased risk of ES-R.

Condensed Abstract

This study examined retrospectively the impact of recurrences of electrical storm (ES-R) on survival in 87 patients. ES-R was associated with numerically higher long-term all-cause mortality, whereas significantly higher rates of rehospitalization, respectively of acute heart failure were observed.

• Highlights

• ES-R is associated with numerically higher rates of all-cause mortality at long-term follow-up.

• ES-R is associated with significantly higher rates of rehospitalization and numerically higher rates of MACE at long-term follow-up, mainly due to acute heart failure.

• Patients with LVEF ≤35% were 12.4 times more likely to develop ES-R.

     

Beta-Blockers and ACE Inhibitors Are Associated with Improved Survival Secondary to Ventricular Tachyarrhythmia

Objective

The study sought to assess the impact of treatment with beta-blocker (BB) or ACE inhibitor/angiotensin receptor blocker (ACEi/ARB) on secondary survival in patients presenting with ventricular tachyarrhythmia.

Background

Data regarding outcome of patients presenting with ventricular tachyarrhythmia treated with BB and ACEi/ARB is limited.

Methods

A large retrospective registry was used including consecutive patients presenting with ventricular tachycardia and fibrillation from 2002 to 2016 on admission. Applying propensity-score matching for harmonization, the impact of “BB” and “ACEi/ARB” was comparatively evaluated. The primary prognostic outcome was long-term all-cause death at 3 years.

Results

A total of 972 matched patients were included. Both patients with BB (long-term mortality rate 18 versus 27%; log rank p?=?0.041; HR?=?0.661; 95% CI?=?0.443–0.986; p?=?0.043) and with ACEi/ARB (long-term mortality rate 13 versus 23%; log rank p?=?0.004; HR?=?0.544; 95% CI?=?0.359–0.824; p?=?0.004) revealed better secondary survival compared to patients without after presenting with ventricular tachyarrhythmia on admission. The prognostic benefit of BB was comparable to ACEi/ARB (long-term mortality rate 21 versus 26%; log rank p?=?0.539).

Conclusion

BB and ACEi/ARB were associated with improved secondary survival in patients surviving ventricular tachyarrhythmia on admission.

Trial Registration

ClinicalTrials.gov identifier: NCT02982473