It is time to check estimated glomerular filtration rate level in implantable cardioverter-defibrillator patients

Abstract

ischaemic cardiomyopathy and ICDs. Among 274 consecutive patients with non-ischaemic cardiomyopathy and ICDs, there were 96 (35%) patients with eGFR ,60 mL/min/1.73 m 2 .A s expected, patients with decreased eGFR levels were older and had higher brain natriuretic peptide (BNP) levels, but other clinical and ECG parameters did not show any significant difference between patients with eGFR below and above 60 mL/min/ 1.72 m 2 . During the median 27 month follow-up, appropriate ICD therapy occurred in a significantly higher number of patients (59%) with decreased eGFR than in patients with normal eGFR levels (40%). Interestingly, the proportion of patients receiving ICD therapy for ventricular tachycardia or fibrillation was similar in both groups. Also, electrical storms were observed twice more frequently in patients with a decreased eGFR than the normal eGFR (33 vs. 17%, respectively). A 4 year mortality rate was estimated at 32% for patients with a decreased eGFR and 22% in patients with a normal eGFR. In multivariate analysis, a decreased eGFR was significantly associated with increased risk of appropriate therapy after adjustment for relevant covariates. This manuscript provides an important addition to the literature describing for the first time the association between eGFR levels and outcome in patients with non-ischaemic cardiomyopathy and ICDs. Similarly to what was described for ischaemic cardiomyopathy ICD patients, 4,5 it proves that non-ischaemic ICD patients with a decreased eGFR have significantly increased risk of mortality and increased risk of ventricular arrhythmias requiring ICD therapy. A very important aspect of the analysis focuses on 207 patients in whom eGFR level was re-evaluated after 1 year. A decreased eGFR of 15 mL/min/m 2 was observed in 36% of patients who exhibited an increased propensity to arrhythmic events. This observation stresses the need for continuous follow-up of these high-risk patients whose dynamic disease process might alter their status towards the high-risk category. There are a few remaining questions regarding the data presented in this paper. It would be beneficial to know the proportion