Implantable Cardioverter-defibrillator Insertion Research Articles

The impact of supraventricular arrhythmias on the outcomes of guideline-compliant implantable cardioverter defibrillator programming.

Several implantable cardioverter defibrillators (ICD) programming strategies are applied to minimize ICD therapy, especially unnecessary therapies from supraventricular arrhythmias (SVA). However, it remains unknown whether these optimal programming recommendations only benefit those with SVAs or have any detrimental effects from delayed therapy on those without SVAs. This study aims to assess the impact of SVA on the outcomes of ICD programming based on 2015 HRS/EHRA/APHRS/SOLAECE expert consensus statement and 2019 focused update on optimal ICD programming and testing guidelines. Consecutive patients who underwent ICD insertion for primary prevention were classified into four groups based on SVA status and ICD programming: (1) guideline-concordant group (GC) with SVA, (2)GC without SVA, (3) nonguideline concordant group (NGC) with SVA, and (4)NGC without SVA. Cox proportional hazard models were analyzed for freedom from ICD therapies, shock, and mortality. Seven hundred and seventy-two patients (median age, 64 years) were enrolled. ICD therapies were the most frequent in NGC with SVA (24.0%), followed by NGC without SVA (19.9%), GC without SVA (11.6%), and GC with SVA (8.1%). Guideline concordant programming was associated with 68% ICD therapy reduction (HR 0.32, p = .007) and 67% ICD shock reduction (HR 0.33, p = .030) in SVA patients and 44% ICD therapy reduction in those without SVA (HR 0.56, p = .030). Programming ICDs in primary prevention patients based on current guidelines reduces therapy burden without increasing mortality in both SVA and non-SVA patients. A greater magnitude of reduced ICD therapy was found in those with supraventricular arrhythmias.

Трудности подбора генно-инженерной терапии у пациента с поражением сердечно-сосудистой системы при анкилозирующем спондилите (болезни Бехтерева)

Spondylarthritis (SpA) is a group of chronic inflammatory diseases affecting the spine, joints, and entheses. It is characterized by common clinical, radiological, and genetic traits. Cardiovascular disorder (CVD) is an important factor in determining the prognosis and treatment options for SpA. Ankylosing spondylitis (AS) is the reference axial SpA, where CVD is a manifestation of both systemic inflammation and rapid atherosclerotic lesion secondary to the disease. Treating AS associated with CVD is challenging because nonsteroidal anti-inflammatory drugs and physical activity exacerbate cardiovascular disease, while experience with gene therapy and targeted therapy is limited. Therefore, it is important to accumulate real-world clinical data on treating patients with AS and CVD. This article discusses the case of a patient with AS and CVD who developed secondary resistance to tumor necrosis factor α inhibitor. The patient required complex cardiotropic therapy, including implantable cardioverter defibrillator insertion and replacement of genetically engineered drug with interleukin 17A inhibitor. The article also discusses the rationale for the chosen management strategy from a CVD perspective. KEYWORDS: ankylosing spondylitis, Bechterew's disease, axial spondylarthritis, atrioventricular block, cardiovascular comorbidity, biological therapy, interleukin 17A. FOR CITATION: Gaydukova I.Z., Sidorchuk I.V., Chudinov A.L., Inamova O.V. Difficulties in selecting genetically engineered therapy in a patient with cardiovascular disorder in ankylosing spondylitis (Bechterew's disease). Russian Medical Inquiry. 2024;8(2):89–93 (in Russ.). DOI: 10.32364/2587-6821-2024-8-2-6.

The Effect of Education, Telephone Monitoring on Self-Efficacy and Shock Anxiety of Implantable Cardioverter Defibrillator Patients

Objective: Implantable cardioverter defibrillators (ICDs), which are used in the treatment of fatal ventricular arrhythmias, have many life-saving benefits. On the other hand, it has negative effects in terms of physical, social and psychological aspects by commonly causing anxiety and depression. The aim of this study is to examine the effects of education and telephone monitoring on self-efficacy and shock anxiety in patients with implantable cardioverter defibrillator implantation.
 Methods: 65 patients hospitalized for ICD insertion were randomly divided into intervention (n=33) and control (n=32) groups. The intervention group was given a training booklet prepared by one-on-one training about ICD. Telephone monitoring was performed once every two weeks for three months and then once a month. No intervention was applied to the control group. Self-Efficacy and Outcome Expectation Scales, Florida Shock Anxiety Scale were applied in the third and sixth months after ICD implantation in both groups.
 Results: The self-efficacy scores at the sixth month were higher in the intervention group than in the control group (p=.03). There was no difference between the shock anxiety scores at 3 months (p=.58) and 6 months (p=.64) between the groups. Shock anxiety mean scores of both groups in the 6th month are lower than the mean scores in the 3rd month (p

Modeling the Relationship Between Diastolic Phenotype and Outcomes in Pediatric Hypertrophic Cardiomyopathy

Pediatric hypertrophic cardiomyopathy (HCM) is associated with adverse events. The contribution of diastolic dysfunction to adverse events is poorly understood. The aim of this study was to explore the association between diastolic phenotype and outcomes in pediatric patients with HCM. Children <18years of age with diagnosed with HCM were included. Diastolic function parameters were measured from the first echocardiogram at the time of diagnosis, including Doppler flow velocities, tissue Doppler velocities, and left atrial volume and function. Using principal-component analysis, key features in echocardiographic parameters were identified. The principal components were regressed to freedom from major adverse cardiac events (MACE), defined as implantable cardioverter-defibrillator insertion, myectomy, aborted sudden cardiac death, transplantation, need for mechanical circulatory support, and death. Variables that estimate left ventricular filling pressures were highly collinear and associated with MACE (hazard ratio, 0.86; 95% CI, 0.75-1.00), though this was no longer significant after controlling for left ventricular thickness and genetic variation. Left atrial size parameters adjusted for body surface area were independently associated with outcomes in the covariate-adjusted model (hazard ratio, 0.69; 95% CI, 0.5-0.94). The covariate-adjusted model had an Akaike information criterion of 213, an adjusted R2 value of 0.78, and a concordance index of 0.82 for association with MACE. Echocardiographic parameters of diastolic dysfunction were associated with MACE in this population study, in combination with the severity of left ventricular hypertrophy and genetic variation. Left atrial size parameters adjusted for body surface area were independently associated with adverse events. Additional study of diastolic function parameters adjusted for patient size could facilitate the prediction of adverse events in pediatric patients with HCM.

Complications of Implantable Cardioverter Defibrillator and Their Potential Risk Factors in Patients with Hypertrophic Cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) has different complications such as cardiac arrhythmia and sudden cardiac death (SCD). Insertion of an implantable cardioverter defibrillator (ICD) is recommended for HCM patients who are at high risk of SCD and malignant arrhythmias, despite having their own potential complications. Hypothesis. We aimed to investigate the prevalence of different complications of ICD insertion and the impact of the potential influential baseline characteristics in a one-year follow-up period. This was a retrospective study with a total of 71 HCM patients with ICD insertion. We evaluated the prevalence of different complications of ICD implantation and the impact of baseline characteristics on the occurrence of ICD complications using multivariate regression analysis in three 4-month periods. In a one-year follow-up, 13 patients (18.3%) experienced at least one of the complications including pneumothorax, lead failure, ICD infection, inappropriate shocks, perforation, and upper limb deep vein thrombosis (DVT) with no mortality. Inappropriate shocks were reported as the most common (11.3%) complication during this period, with a gradual increase in the second (4.2%) and third (5.6%) follow-up sessions. Among all of the baseline characteristics that were investigated in this study, a positive history of hypertension was the only risk factor with significant impact on the occurrence of complications (P = 0.01). We demonstrated the occurrence of complications during a one-year follow-up as 18.3% in HCM patients with ICD insertion. A positive history of hypertension was the only baseline characteristic affecting the occurrence of complications, and inappropriate shocks were the most common complication.

Long-term outcomes in carriers of the familial idiopathic ventricular fibrillation linked to the DPP6 locus

Abstract Background Idiopathic ventricular fibrillation (IVF) is a malignant condition with no clinical sequelae except for ventricular fibrillation. The genetic basis is ill-defined but in 2009 a Dutch founder variant - the DPP6 risk haplotype - was linked to a familial form of IVF characterized by a very high incidence of sudden cardiac arrest (SCA) and sudden cardiac death (SCD). Consequently, for more than a decade asymptomatic haplotype-carriers from the ages of 18 (male) and 25 (female) have had an implantable cardioverter-defibrillator (ICD) inserted. However, the associated long-term outcomes in these individuals is unknown. Purpose To assess the long-term outcomes of DPP6 risk haplotype-carriers who presented to our tertiary referral center and qualified for ICD insertion. Methods Clinical follow-up information of DPP6 risk haplotype-carriers, including the occurrence of SCD, SCA, appropriate ICD shocks, and ICD-related complications, was collected through February 2023. ICD-carriers were classified as either asymptomatic (primary prevention), or with previous sudden cardiac arrest (secondary prevention). Survival rates are presented using a survival curve and were compared with the log-rank test. Results A total of 118 haplotype-carriers (62 males) were included. One-hundred nine (92%) carriers had an ICD inserted, for primary (n=85) or secondary prevention (n=24), and 9 patients refused a primary prevention ICD. Among primary prevention ICD-carriers and those who refused implantation (n=94), 9 (10%) patients experienced a total of 28 appropriate shocks, there was 1 SCA and no deaths, during a median follow-up of 11 years (IQR 7-13; Figure). Of these, 9 patients were ever treated with quinidine and 5 still used quinidine at last follow-up. Among secondary prevention ICD carriers, 20 (83%) patients experienced a total of 225 appropriate shocks and one patient died, during a median follow-up of 13 years (IQR 10-16). Of these patients, 11 were ever treated with quinidine, of whom one patient discontinued quinidine due to adverse effects. Overall, 14 (13%) patients experienced inappropriate shocks and 16 (15%) experienced other ICD-related complications. Conclusion Predictive genetic testing of the DPP6 haplotype provides the unique opportunity to identify asymptomatic family members at risk for SCD and insert prophylactic ICDs just on the basis of carrying the risk haplotype. Approximately 10% of DPP6 haplotype-carriers who qualified for ICD insertion for primary prevention, predominantly males, experienced appropriate ICD shocks or SCA during 11 years of follow-up, indicating that our approach to ICD implantation has presumably saved several lives. In those with an ICD for secondary prevention the incidence of appropriate ICD shocks was high, often despite quinidine therapy.Survival until appropriate shock or SCA

Outcomes Following Implantable Cardioverter-Defibrillator Insertion in Patients 80 Years of Age or Older: A Statewide Population Cohort Study

BackgroundPatients ≥ 80 years of age are underrepresented in major implantable cardioverter-defibrillator (ICD) trials, and real-world data are lacking. In this study, we sought to assess ICD utilisation, outcomes, and their predictors, in an unselected statewide population including patients ≥ 80 years old. MethodsWe extracted details of ICDs implanted from 2009 to 2018 in New South Wales (NSW), Australia from the Centre for Health Record Linkage administrative data sets. Analysis was stratified into age groups of < 60 years, 60-79 years, and ≥ 80 years. ResultsA total of 9304 patients (mean age 66.1 ± 13.1 years; 12.1% ≥ 80 years) had de novo ICD placement at an average rate of 1163 ± 122 patients per annum, with more implants in men in all age groups. After adjusting for NSW population size by sex, age group, and calendar year, mean implantation rates were 5.5 ± 0.6, 63.2 ± 8.6, and 52.7 ± 10.8 per 100,000 persons per annum in patients aged < 60 years, 60-79 years, and ≥ 80 years, respectively. In-hospital mortality was 0.4% and did not differ among age groups. However, 1-year mortality was 2.1%, 5.9%, and 10.7%, in those < 60 years, 60-79 years, and ≥ 80 years of age, respectively (P < 0.001), with hazard ratios for those aged ≥ 80 years of 4.3 (95% confidence interval [CI] 3.1-6.0) and those aged 60-79 years of 2.6 (95% CI 1.9-3.5) relative to those aged < 60 years (both P < 0.001) after adjusting for ICD indications, sex, implantation year, referral source, and comorbidities. In those aged ≥ 80 years, age > 83 years, congestive cardiac failure, chronic renal failure, neurodegenerative disease, and a higher Charlson comorbidity index score were each independent predictors of 1-year mortality. ConclusionsICD use in patients aged ≥ 80 years and 60-79 years was 10-fold that in patients aged < 60 years, and perioperative outcomes were good in all ages, but there was substantially increased 1-year mortality in those aged ≥ 80 years. Careful selection based on age and comorbidity may further reduce 1-year mortality in patients ≥ 80 years old receiving ICDs.

Sternoclavicular Joint Osteomyelitis Post Implantable Cardioverter Defibrillator Insertion: A Case Report

Background: Implantable Cardioverter Defibrillator is a rare source of sternoclavicular joint (SCJ) infection. Management of SCJ infection is challenging because of the joint's proximity to major vascular structures. Case Presentation:: We presented a case of SCJ infection two years post implantable cardioverter-defibrillator insertion in a 70-year-old gentleman. We managed the patient successfully with minimal surgical debridement, followed by negative pressure suction and antibiotic therapy for eight weeks. Discussion: Management of SCJ after implantable ICD is still challenging. Few cases reported the possibility of negative wound suction to manage this condition after wound debridement. Our case may support the conservative approach to managing SCJ infection. Conclusion: SCJ infection can occur for a long time following ICD insertion. Wound debridement followed by negative wound therapy could be beneficial in the management of this condition

A case of spontaneous pneumomediastinum, pneumothorax with subcutaneous emphysema in a preschool child

Spontaneous subcutaneous emphysema is the presence of gas or air beneath the skin and soft tissues. Pneumothorax and pneumomediastinum are identified by the existence of free gas or air in the associated spaces. 4-year-old with progressive body swelling of 12-hour duration, started just after nebulisation with bronchodilators prescribed for his cough and cold. Examination revealed conscious, anxious, irritable child and obvious superficial swelling of face, scalp, neck, chest and both upper limbs. tachycardia, tachypnoea and his oxygen saturation were 82% at the time of admission. There was crepitus on palpation. Investigations were done; A diagnosis of spontaneous pneumomediastinum, left pneumothorax with spontaneous subcutaneous emphysema was made. Managed with emergency implantable cardioverter-defibrillator (ICD) insertion, oxygen, intravenous antibiotics, intravenous fluids, analgesics, and nebulisation.

Neuroticism and sudden cardiac death: a prospective cohort study from UK biobank.

There is a paucity of evidence on the risk of sudden cardiac death (SCD) according to the degree of neuroticism. We sought to evaluate the association between neuroticism and the long-term risk of SCD. From the UK Biobank nationwide prospective cohort, participants free from previous SCD, ventricular arrhythmias, implantable cardioverter-defibrillator (ICD) insertion, depression, schizophrenia, and bipolar disorder were selected. The 12-item scale of neuroticism measurement (neuroticism score) was categorized into high (≥ 3) and low (< 3) groups. The primary outcome was SCD including ventricular fibrillation (VF) at median 12.6years of follow-up. The outcomes were compared between the groups using multivariable Cox regression and inverse probability of treatment weighting (IPTW). A total of 377,563 participants (aged 56.5 ± 8.1, 53.1% women) were analyzed. The high neuroticism score group had a significantly lower risk of SCD (adjusted hazard ratio [aHR] = 0.87, 95% confidence interval [CI] 0.79-0.96, P = 0.007; IPTW-adjusted HR [IPTW-HR] 0.87 [0.77-0.97], P = 0.016) than the low neuroticism score group. The effect of a high neuroticism score on the decreased risk of SCD was more prominent in women (IPTW-HR 0.71 [0.56-0.89], P = 0.003) than in men (IPTW-HR 0.93 [0.82-1.07], P = 0.305, P-for-interaction = 0.043). Sex differences were observed among independent predictors for incident SCD, emphasizing the protective role of a high neuroticism score and moderate-to-vigorous physical activity only in women. A high neuroticism score was significantly associated with a lower risk of SCD, particularly in women. Efforts to unveil the causal and mechanistic relationship between personality phenotypes and the risk of SCD should be continued.

Bilateral Cardiac Sympathetic Denervation as a Safe Therapeutic Option for Ventricular Arrhythmias.

The recurrence of ventricular arrhythmias (VAs) in patients who have already undergone treatment with antiarrhythmic medication, catheter ablation, and the insertion of implantable cardioverter defibrillators is not uncommon. Recent studies have shown that bilateral cardiac sympathetic denervation (BCSD) effectively treats VAs. However, only a limited number of studies have confirmed the safety of BCSD as a viable therapeutic option for VAs. This single-center study included 10 patients, who had a median age of 54 years (interquartile range [IQR], 45-65 years) and a median ejection fraction of 58.5% (IQR, 56.2%-60.8%), with VAs who underwent video-assisted BCSD. BCSD was executed as a single-stage surgery for 8 patients, while the remaining 2 patients initially underwent left cardiac sympathetic denervation followed by right cardiac sympathetic denervation. We evaluated postoperative complications, the duration of hospital stays, and VA-related symptoms before and after surgery. The median hospital stay after surgery was 2 days (IQR, 2-3 days). The median surgical time for BCSD was 113 minutes (IQR, 104-126 minutes). No significant complications occurred during hospitalization or after discharge. During the median follow-up period of 13.5 months (IQR, 10.5-28.0 months) from surgery, no VA-related symptoms were observed in 70% of patients. The benefits of a short postoperative hospitalization and negligible complications make BCSD a safe, alternative therapeutic option for patients suffering from refractory VAs.

The impact of implantable cardioverter defibrillator on the prognosis of nonischemic dilated cardiomyopathy patients compared with standard medical treatments.

Patients with nonischemic dilated cardiomyopathy (DCM)are susceptible to arrhythmias and implantable cardioverter defibrillator (ICD)in addition to medical treatments may help prevent sudden cardiac death (SCD)and improve survival in this population. We aim to investigate the impact of ICD insertion on survival and prognosis of patients with nonischemic DCM. We retrospectively analyzed data from patients with nonischemic DCM treated with medical therapy with or without ICD who referred to our hospital from January 2020 to November 2021. Patients were divided based on the treatment that they had received into two equal groups. Different variables including demographic features, comorbidities, medical treatments, hospitalization rate, function class,and left ventricular ejection fractionbefore and after treatments were investigated in this study. In addition, variables in survival including overall survival (OS) andSCDwere compared between the two groups. A total of 120 patients were investigated in this study. Mean ± SDof age and follow-up time of patients were 64.0 ± 12.7 years old and 61.2 ± 15.9 months, respectively. Ten (16.7%) patients with medical therapy, and seven (11.7%) patients with ICD and medical therapy died during the follow-up period (p = 0.25).However, the two groups had a significant difference regarding SCD (11.7% vs. 1.7%, p = 0.02). In patients with nonischemic DCM who had undergone ICD insertion in addition to standard medical treatments, SCD was significantly reduced compared with patients receiving just medical treatments. OS had no significant difference between our two studied groups.

Efficacy and safety of catheter ablation as first-line therapy for the management of ventricular tachycardia

BackgroundVentricular tachycardia (VT) is associated with significantly increased morbidity and mortality. Catheter ablation (CA) in line with an implantable cardioverter-defibrillator (ICD) is highly effective in VT management; however, it is unknown if CA should be considered as first-line therapy. The aim of this study is to verify the efficacy and safety of CA as first-line therapy for the first VT presentation (as adjunctive to ICD insertion), compared to initial ICD insertion and anti-arrhythmic drug (AAD) therapy.MethodsData from patients with the first presentation for VT from January 2017 to January 2021 was reviewed. Patients were classified as “ablation first” vs “ICD first” groups and compared the clinical outcomes between groups.ResultsOne hundred and eighty-four consecutive patients presented with VT; 34 underwent CA as first-line therapy prior to ICD insertion, and 150 had ICD insertion/AAD therapy as first‐line. During the median follow-up of 625 days, patients who underwent CA as first-line therapy had significantly higher ventricular arrhythmia (VA)-free survival (91% vs 59%, log-rank P = 0.002) and composite of VA recurrence, cardiovascular hospitalization, transplant, and death (84% vs 54%, log-rank P = 0.01) compared to those who did not undergo CA. Multivariate analysis revealed that first-line CA was the only protective predictor of VA recurrence (hazard ratio (HR) 0.20, P = 0.003). There were 3 (9%) peri-procedural complications with no peri-procedural deaths.ConclusionReal-world data supports the efficacy and safety of CA as first-line therapy at the time of the first VT hospitalization, compared to the initial ICD implant and AAD therapy.

Major gaps in the information provided to patients before implantation of cardioverter defibrillators: a prospective patient European evaluation.

Information provided to patients prior to implantable cardioverter-defibrillator (ICD) insertion and their participation in the decision-making process are crucial for understanding ICD function and accepting this lifelong therapy. The aim of this study is to evaluate the extent to which different aspects related to ICD and quality of life were transmitted to patients prior to ICD implantation. Prospective, multicenter European study with an online questionnaire initiated by the European Heart Rhythm Association. The questionnaire was filled-in directly and personally by the ICD patients who were invited to participate. A total of 1809 patients (majority in their 40s-70s, with 624 women, 34.5%) from 10 European countries participated in the study. The median time from first ICD implantation was 5 years (interquartile range 2-10). Overall, 1155 patients (71.5%) felt optimally informed at the time of device implantation, however many respondents received no information about ICD-related complications (n = 801, 49.6%), driving restrictions (n = 718, 44.5%), and possibility of end-of-life ICD deactivation (n = 408, 25.4%). Of note, women were less frequently involved in the decision-making process than men (47.3% vs. 55.9%, P = 0.003) and reported to be less often optimally informed before ICD implantation than men (61.2% vs. 76.8%, P < 0.001). More women mentioned the desire to have learned more about ICD therapy and the benefit/risk balance (45.4% vs. 33.7% of men; P < 0.001). This patient-based evaluation provides alarming findings on the lack of information provided to patients prior ICD implantation, particularly for women.

Comprehensive Phenotypic Characterization of Late Gadolinium Enhancement Predicts Sudden Cardiac Death in Coronary Artery Disease

BackgroundLate gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) offers the potential to noninvasively characterize the phenotypic substrate for sudden cardiac death (SCD). ObjectivesThe authors assessed the utility of infarct characterization by CMR, including scar microstructure analysis, to predict SCD in patients with coronary artery disease (CAD). MethodsPatients with stable CAD were prospectively recruited into a CMR registry. LGE quantification of core infarction and the peri-infarct zone (PIZ) was performed alongside computational image analysis to extract morphologic and texture scar microstructure features. The primary outcome was SCD or aborted SCD. ResultsOf 437 patients (mean age: 64 years; mean left ventricular ejection fraction [LVEF]: 47%) followed for a median of 6.3 years, 49 patients (11.2%) experienced the primary outcome. On multivariable analysis, PIZ mass and core infarct mass were independently associated with the primary outcome (per gram: HR: 1.07 [95% CI: 1.02-1.12]; P = 0.002 and HR: 1.03 [95% CI: 1.01-1.05]; P = 0.01, respectively), and the addition of both parameters improved discrimination of the model (Harrell’s C-statistic: 0.64-0.79). PIZ mass, however, did not provide incremental prognostic value over core infarct mass based on Harrell’s C-statistic or risk reclassification analysis. Severely reduced LVEF did not predict the primary endpoint after adjustment for scar mass. On scar microstructure analysis, the number of LGE islands in addition to scar transmurality, radiality, interface area, and entropy were all associated with the primary outcome after adjustment for severely reduced LVEF and New York Heart Association functional class of >1. No scar microstructure feature remained associated with the primary endpoint when PIZ mass and core infarct mass were added to the regression models. ConclusionsComprehensive LGE characterization independently predicted SCD risk beyond conventional predictors used in implantable cardioverter-defibrillator (ICD) insertion guidelines. These results signify the potential for a more personalized approach to determining ICD candidacy in CAD.

Prediction of Left Ventricular Ejection Fraction Change Following Treatment With Sacubitril/Valsartan

BackgroundSacubitril/valsartan (Sac/Val) improves left ventricular ejection fraction (LVEF) in heart failure (HF) with reduced ejection fraction regardless of previous treatments. Improvements in LVEF may change eligibility for primary implantable cardioverter-defibrillator (ICD) placement. Awaiting LVEF improvement may expose patients to potential risks for arrhythmic complications. ObjectivesThe authors sought to develop a model predicting LVEF change after Sac/Val therapy. MethodsA total of 416 persons with HF and LVEF of <35% were included in this analysis. Following initiation of Sac/Val, echocardiographic parameters were measured serially for 1 year. A machine learning algorithm was implemented to develop a risk model for predicting the persistence of LVEF of <35% after 1 year and was validated in a separate group of study participants. ResultsBaseline LVEF, left ventricular mass index, HF duration, age, N-terminal pro–B-type natriuretic peptide concentration at baseline and change by day 14, and body mass index were the most significant factors for identifying lack of LVEF improvement to ≥35% after 1 year. In the training and validation cohorts, the areas under the model curve for predicting lack of LVEF improvement were 0.92 and 0.86, respectively. Three categories of likelihood for LVEF of <35% after 1 year of Sac/Val treatment were developed based on the model predictions: 3.8%, 30.1%, and 83.7%. During follow-up, arrhythmia event rates were 0.9%, 2.9%, and 6.7% in these groups, respectively. ConclusionsMany persons with HF with reduced ejection fraction eligible for ICD insertion experience an increase in LVEF to ≥35% after treatment with Sac/Val. Early identification of those less likely to improve their LVEF might allow for more refined selection of primary ICD candidates. (Effects of Sacubitril/Valsartan Therapy on biomarkers, Myocardial Remodeling, and Outcomes [PROVE-HF]; NCT02887183)

Abstract 15895: Causes and Predictors of 30-Day Readmission After Implantable Cardioverter/Defibrillator Insertion in Heart Failure Patients: Insight From the National Readmissions Database

Introduction: Implantable Cardioverter/Defibrillator (ICD) insertion in heart failure (HF) patients with ejection fraction below 30% and at least 40 days post-infarction is rapidly becoming commonplace. Given the high prevalence of ICD insertions in HF patients with reduced ejection fraction (HFrEF) we aimed to analyze the rates and causes of readmissions in this specific population. Methods: We utilized the National Readmission Database from 2018 to identify hospitalized adults with HF who underwent ICD insertion. We included those who were readmitted within 30 days after the index admission. We excluded elective and traumatic admissions. A multivariate cox regression model was used to identify independent predictors of readmission. Results: During the study period, 283,539 hospitalized patients with HF who underwent ICD insertion were discharged alive. Within 30-days from discharge, 46,537 (16.4%) were readmitted. The top three causes of readmission were heart failure (35.2%), sepsis (5.26%), and ventricular tachycardia (4%). Readmitted patients were more likely to be discharged to nursing facility (45% vs 38%; p&lt;0.001), had higher rates of Medicare/Medicaid (89.2% vs 78.7%; p&lt;0.001) and annual income &lt; $44,000 (35.7% vs 33%; p&lt;0.001). In-hospital mortality (5.6% vs 3.4%; p&lt;0.001) was higher during readmission. Figure 1 shows the Forrest plot of multivariate analysis of independent factors associated with readmissions. Conclusions: We identified social and clinical predictors of readmission after ICD insertion in those with HF such as household income, discharge to a nursing home, renal/lung disease, and intubation during their index admission. Healthcare systems should use this data to target modifiable factors to prevent readmissions as this can help ease the burden placed on the resources of the American healthcare system and improve clinical outcomes for patients.

Abstract 13009: Time to Implantable Cardioverter Defibrillator in Patients With Left Ventricular Ejection Fraction ≤ 35%

Background: Implantable cardioverter-defibrillators (ICDs) are endorsed by the current American Heart Association (AHA) Guidelines as the cornerstone in the primary prevention of mortality in patients with reduced ejection fraction (EF) (≤35%). The timing for ICD therapy in non-ischemic cardiomyopathy (NICM) is not specified in the current guidelines. The objective of this study was to determine the timing for ICD insertion for patients with NICM versus ICM in the real-world population. Methods: Retrospective design study of patients with ICDs implantation from 2019 to 2022 at our community hospital. Data was obtained via the Device Implant Registry. All eligible participants had confirmed diagnosis of ICM and NICM on chart review; while confirmed EF≤35% on echocardiography. Categorical predictors and clinical outcomes were analyzed using Pearson’s chi-square test or Fisher’s exact test. Quantitative predictors and clinical outcomes were analyzed using Student's t-test or the Wilcoxon rank sum test. Results: Our cohort included 62 patients undergoing ICD placement for primary prevention. There was no statistical significance between patients based on age, sex, race, and EF. Average time to ICD placement was 134 days for patients with ICM and 274 days for patients with NICM, a difference that favoured NICM; p =0.009 ( p &lt;0.05). In the majority of patients, 64.5%, ICD implantation was deferred for at least 90 days compared to 35.5% patients who had an ICD placed by 90 days; p =0.001 ( p &lt;0.05). The mortality in our study was 13% over a median of 2 years, with a predominance of ICM as compared to NICM, 75% versus 25%, respectably. Logistics regression demonstrated that timing to ICD implantation was not an independent variable of mortality. The mean overall survival was 274.4 days (SD +/- 50) in NICM compared to 134.3 days (SD +/- 21) in the ICM group, p =0.007 ( p &lt;0.05). Conclusions: In a real-world population, time to ICD implantation was statistically different in ICM compared to NICM. ICM remains a significant risk of all-cause mortality despite the progress made in both medical and procedural treatments. Further studies are necessary to determine the appropriate time to ICD implantation in patients with NICM and reduced EF.

PREDICTING LONG-TERM SURVIVAL AFTER DE NOVO CARDIOVERTER DEFIBRILLATOR IMPLANTATION FOR PRIMARY PREVENTION

Current guidelines recommend use of implantable cardioverter-defibrillators (ICDs) for the primary prevention of arrhythmia and sudden cardiac death in patients with reduced ejection fraction cardiomyopathy. While the mortality benefit of ICD insertion has been established in landmark randomized controlled trials, little is known about the long-term outcomes of patients with ICDs in clinical practice. We aimed to develop a risk prediction model for 10-year survival after ICD implantation for primary prevention.

Approaches for monitoring and treating cardiomyopathy among cancer survivors following anthracycline or thoracic radiation treatment

BackgroundAnthracycline chemotherapy and thoracic radiation therapy (RT) are known causes of cardiomyopathy among cancer survivors, however, management guidelines for this population are lacking. In this study we describe our single institution management approach for cancer survivors with low left ventricular ejection fraction (LVEF) secondary to cancer treatment.MethodsWe conducted a retrospective descriptive study of childhood and young adult (CAYA) cancer survivors in the Adult Long-Term Follow-Up Clinic at Memorial Sloan Kettering Cancer Center enrolled between November 2005 and July 2019. Those included were treated with anthracycline and/or thoracic RT as a part of their cancer therapy and had recorded a LVEF of < 55% on at least one post-treatment echocardiogram. Details regarding survivor characteristics, screening, and management were abstracted. Differences in management approaches among survivors with LVEF of 50–54.9%, 40–49.9%, and < 40% were described. Qualitative management approaches were abstracted as well.ResultsAmong 668 CAYA survivors in the initial cohort, 80 were identified who had received anthracycline and/or thoracic RT and had a LVEF of < 55%. Median age at cancer diagnosis was 16.1 years, median time from cancer diagnosis was 25.8 years, and 55% of survivors were female. Cardiology referrals, nuclear stress tests, multi-gated acquisition scans, angiograms, echocardiograms, treatment with angiotensin converting enzyme inhibitors or receptor blockers, beta-blockers, diuretics, aldosterone antagonists, aspirin, and insertion of pacemaker or implantable cardioverter-defibrillators differed by LVEF category. Documentation suggested uncertainty regarding management of survivors with borderline low-LVEF, with low-LVEF that improved on follow-up, and with subsequent cancers requiring additional treatment.ConclusionsThe management of CAYA cancer survivors with low-LVEF largely followed guidelines designed for the general population, however, uncertainty remains for issues specific to cancer survivors. Cardiomyopathy management guidelines that address issues specific to cancer survivors are needed.