EP News: Allied Professionals

Abstract

From a single center located in an area with a high prevalence of human immunodeficiency virus (HIV) infection, Alvi et al (J Am Heart Assoc 2018;7:e009857, PMID 30371221) sought to assess the incidence, predictors, and effects of implantable cardioverter-defibrillator (ICD) therapy in patients living with HIV (PHIV). They studied a group of patients admitted for decompensated heart failure (HF) who had an ICD and who were followed up at their center. Using retrospective chart review, they assessed a number of clinical variables and follow-up data over a median follow-up of 19 months. ICD therapies were adjudicated as appropriate (for ventricular tachycardia or fibrillation) or inappropriate (for supraventricular arrhythmias such as atrial fibrillation or flutter or abnormal sensing) by an electrophysiologist. Of the total of 326 patients with HF and ICD, 59 (18%) were PHIV and were compared with 267 uninfected controls (81%). These groups were similar in many variables including primary or secondary prevention ICD, type of ICD (single chamber, dual chamber, or cardiac resynchronization), age, sex, use of antiarrhythmic medications, and left ventricular ejection fraction. The PHIV group had a higher incidence of coronary artery disease (CAD) and cocaine use than did the uninfected group. Of the 326 patients, 147 (45%) received ICD therapy, with 83 (23%) receiving ICD shock (described as 13% appropriate and 10% inappropriate shocks) and 85 (22%) had antitachycardia pacing (ATP) (described as 11% appropriate and 11% inappropriate ATP). Compared with uninfected controls, PHIV had a higher incidence of ICD shocks and ATP (64% vs 28%; P = .001). In multivariate analysis, cocaine use, history of CAD, longer QRS duration, and higher New York Heart Association HF class were predictors of ICD shocks in PHIV. Among the PHIV group receiving ICD shocks, cardiovascular (CV) mortality and 30-day HF admission were higher in those with ICD shocks vs those without shocks. This was driven by those with appropriate shocks since there was difference in HF admission and CV mortality between those with appropriate shocks and those with no shocks. However, there was no statistically significant difference in those with inappropriate ICD shock vs no ICD shock or ATP (appropriate or inappropriate) vs without ATP. Similar effects of ICD therapies on 30-day HF admission and CV mortality were noted in the noninfected group. The authors conclude that PHIV have higher rates of ICD discharges than do uninfected controls and that appropriate ICD shocks are associated with increased risk of HF admission and CV mortality.