Primary Prevention Of Sudden Death Research Articles

The era of genes: The importance of genetic research for stratification and therapeutic choice for primary prevention of sudden death in non-ischemic heart failure

The era of genes: The importance of genetic research for stratification and therapeutic choice for primary prevention of sudden death in non-ischemic heart failure

The management of patients with heart failure in Sweden: a survey conducted among physicians in Sweden

Abstract Background Guideline-directed medical therapy (GDMT) improves outcomes in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, real-world studies highlight underutilization of GDMT. Purpose To describe physicians´ general knowledge and opinions on GDMT use, diagnostic workup, and follow-up care in HF in Sweden. Methods A survey comprising 42 multiple-choice questions about HF and its management was sent by mail to a random sample of 828 physicians including any specialist, general practitioners (GP) and interns in Sweden during 2021 and 2022. Answers were reported as percentages and comparisons were made by specialty (general practitioners vs specialists) by the chi-square test. Results 168 physicians (60% males, median age 43) responded to the survey (response rate: 20%), of whom 41% GPs, 18% cardiologists and 13% internists, 24% specialists in training, and 4% other specialists; 72% of participants report to meet less than 10 HF patients per week. Electrocardiography and a New York Heart Association class evaluation are mostly performed once a year by GPs (46%) and at every outpatient visit by other specialists (40%). Echocardiography is mostly requested if there is clinical deterioration (60%). 85% of the participants reported to never assess patient-reported parameters and outcomes with questionnaires. One-third of participants screen for iron deficiency only if there is anemia, and 45% do it every year. Figure 1 reports the major measured obstacles to implementation of GDMT in HFrEF; there were no significant differences according to specialty or age of participants. Implantable cardioverter defibrillation (ICD) implantation for primary prevention of sudden death is deemed appropriate by most responders regardless of aetiology (69%) and patient age (74%). ICD or cardiac resynchronization therapy is considered by most after the three months from optimization of GDMT (61%). Specialists answered correctly to questions to test knowledge on GDMT more often than GPs. 86% of participants think that GDMT should be implemented as much as possible, but only 7% estimate that full optimization is reached in more than 75% of their patients. The main reasons why patients with HFrEF do not receive optimal HF medical therapy (Figure 2) reflect the concern about side effects as well as possible knowledge deficiencies. To maximize the adherence to guidelines, 27% reported that patients should be regularly evaluated in tertiary care and 50% in nurse-led clinics, although for 29% of respondents such facilities are not present. Conclusion Obstacles to GDMT implementation according to physicians in Sweden are mainly related to potential side effects, lack of knowledge and structural aspects, including the lack of availability of nurse-led clinics. Improving implementation may require novel strategies, such as improved access to cardiology specialists, more generalizable trials, and potentially screening for GDMT indications.Figure 1Figure 2

Familial cardiolaminopathy due to a previously undescribed LMNA gene mutation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiolaminopathies are rare genetic alterations, which present diverse mechanical and electrical alterations. OBJECTIVE To present a family carrying an LMNA gene mutation that although not described manifest clinical and electrocardiographic characteristics of the disease. Methods We present the case of two sisters and one brother, aged 65, 57 and 51 years, respectively. At the beginning of their fourth decade, all of them debuted with atrial flutter associated with second and third degree atrioventricular block. Two of them (one or the sisters and the brother) underwent ablation of isthmus-dependent atrial flutter. However, in both, the flutter recurred and no new interventional treatment was further offered. The male subject received a pacemaker implant for treatment of AV block; some years later, he presented a cerebrovascular event and subsequently a recurrence, both while in oral anticoagulation and, actually remains with moderate motor deficit and dysarthria. The youngest woman suffered an embolic cerebrovascular event when she was 50 y/o; she remained asymptomatic in relation to the rhythm disorder and refused a pacemaker. The oldest sister who is asymptomatic, received a pacemaker when she was 45 y/o and now is anticoagulated. By echocardiography, all siblings presented left ejection fraction in between 40 and 50% with decreased strain values and normal left ventricular geometry. Results Recently in our country it is possible to carry out a genetic test, for which the three were subjected to it. In this family, the genetic testing was done using a comercial kit for 172 genes. The result was a Frameshift Indels (non misense) mutation NM_170707.3 c.1526del p.(Pro509LeufsTer39) Exon:9/12, in all three. The caveat is that this LMNA gene mutation has not been previously described. In light of these results, the youngest woman with total AV block and sequelae of cerebrovascular disease and mild left ventricular dysfunction, received an implantable cardiac defibrillator (ICD) implant for primary prevention of sudden death and her siblings are undergoing an upgrade to ICD. Conclusion The mutation found in this family is unique and for the first time reported in the LMNA gene in the world. Genetic diagnosis is limited in our country, which makes it difficult to determine this type of pathology. However, given the clinical presentation of an electrical disorder in all the siblings of a family, in this particular case, it was mandatory to perform this test. These results allow us to better understand the prognosis and intervene appropriately to prevent sudden death, even though there is no treatment to avoid the progression of the disease.

In-hospital predictors for primary prevention of sudden death after acute myocardial infarction with cardiac dysfunction

BackgroundCurrent guidelines recommend prophylactic defibrillator implantation in patients with acute myocardial infarction (AMI) and left ventricular ejection fraction (LVEF) ≤40 % or LVEF ≤35 % plus heart failure symptoms or inducible ventricular tachyarrhythmias during an electrophysiology study at 40 days after AMI or 90 days after revascularization. In-hospital predictors of sudden cardiac death (SCD) after AMI during the index hospitalization remain unsettled. We sought to examine in-hospital predictors of SCD in patients with AMI and LVEF ≤40 % evaluated during the index hospitalization. MethodsWe retrospectively evaluated 441 consecutive patients with AMI and LVEF ≤40 % admitted to our hospital between 2001 and 2014 (77 % male gender; median age: 70 years; median hospitalization length: 23 days). The primary endpoint was a composite of SCD or aborted SCD at ≥30 days after AMI onset (composite arrhythmic event). LVEF and QRS duration (QRSd) on electrocardiography were measured at a median of 12 days and 18 days, respectively. ResultsDuring a median follow-up of 7.6 years, the incidence of composite arrhythmic events was 7.3 % (32 of 441 patients). In multivariable analysis, QRSd ≥100 msec (beta-coefficient = 1.54, p = 0.003), LVEF ≤23 % (beta-coefficient = 1.14, p = 0.007), and onset-reperfusion time > 5.5 h (beta-coefficient = 1.16, p = 0.035) were independent predictors of composite arrhythmic events. The combination of these 3 factors was associated with the highest rate of composite arrhythmic events compared with 0–2 factors (p < 0.001). ConclusionsThe combination of QRSd ≥100 msec, LVEF ≤23 %, and onset-reperfusion time > 5.5 h during the index hospitalization provides precise risk stratification for SCD in patients early after AMI.

PO-04-226 RISK OF VENTRICULAR RECURRENT TACHYARRHYTHMIA IN PATIENTS RECEIVING PRIMARY PREVENTION IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS

Implantable cardioverter-defibrillators (ICDs) have demonstrated efficacy in reducing mortality attributable to sustained ventricular tachyarrhythmia (VTA) and have been used for primary prevention of sudden death. However, patients with primary prevention ICDs remain at risk for first and recurrent VTA, which are associated with increased morbidity and mortality. Currently, there are limited data on factors associated with recurrent VTA after the occurrence of a first episode in this population. Improved risk stratification may help tailor advanced therapies, such as catheter ablation or antiarrhythmic medications, to patients at a high risk for recurrence. The objective of this study was to quantify the risk for recurrent VTA after the occurrence of a first VTA episode among patients with a primary prevention ICD. The population comprised patients enrolled in five landmark ICD trials (MADIT-II, MADIT-Risk, MADIT-CRT, MADIT-RIT, RAID) who experienced a first episode of VTA (defined as ventricular tachycardia [VT] ≥170 bpm or ventricular fibrillation [VF]) after ICD implantation (N=789). The primary endpoint was recurrent VTA after a first episode. All-cause mortality associated with recurrent VTA was a secondary endpoint. Among 789 study patients who experienced a first VTA after ICD implantation, mean age was 63 ± 11 years, 17% were women, 64% had ischemic cardiomyopathy, and mean left ventricular ejection fraction (EF) was 24 ± 7%. Kaplan Meier analysis showed the risk of recurrent VTA after a first episode was very high (60% at 3 years [Figure - A]). Findings were consistent regardless of baseline risk factors, including age, sex, NYHA Class, EF. Furthermore, the burden of multiple VTA episodes after a first episode was also high (average of 3.6 episodes per patient at 3 years [Figure B]). Recurrent VTA was associated with a significant two-fold increased risk of subsequent death (HR=2.15, 95% CI 1.40-3.32, p=0.001 [Figure - C]). Among primary prevention ICD recipients who experience a first VTA, the burden of recurrent VTA and subsequent mortality increase is very high regardless of baseline risk factors. Intensification of therapies, including early catheter ablation, should be considered in primary prevention ICD recipients who experience a first VTA.

Abstract 11009: A Novel Patient-Patient Network Medicine Approach to Refine Hypertrophic Cardiomyopathy Subgrouping: Implications for Risk Stratification

Introduction: In hypertrophic cardiomyopathy (HCM), the presence of left ventricular (LV) apical aneurysm warrants implantable cardioverter defibrillator (ICD) therapy consideration for primary prevention of sudden death (SD). However, a significant proportion of these patients may never experience an SD event. Thus, identifying parameters that modify SD risk in this population may be important clinically, but likely requires phenotyping methods that include robust patient-level information. Methods: Clinical, demographic and echocardiographic parameters were compiled for a large HCM referral population. Variables (N=52) were normalized to the cohort and the Pearson’s correlation was calculated between patients using r&gt;0.6 (after Benjamini-Hochberg correction), selected to maximize the patient:edge ratio. The SD event/risk profile was defined as: SD event/ ≥ 1 major HCM SD risk factor. Results: From N=3,412 HCM patients (male, 62%; 49 17 years at diagnosis) in the network, the clinical profile included maximum LV thickness, 18 4 mm; left atrial diameter, 41 7 mm; LV outflow tract gradient 30 mmHg, and N=68 (3%) patients with LV apical aneurysm. We identified N=17 distinct patient modules (range, N=19-483 patients/module). Module #15 was highly enriched for LV apical aneurysm (N=56/56); however, the SD event rate was significantly less compared to LV apical aneurysm patients in all other modules (N=12; 4% vs. 75%; P&lt;0.0001). Lower blood pressure and smaller left atrial size delineated LV apical aneurysm patient in module #15. Conclusions: This proof-of-concept patient-patient network analysis suggests that lower blood pressure and smaller left atrial size may contribute to a favorable SD risk profile among HCM LV apical aneurysm patients.

Prevention of sudden death in heart failure with reduced ejection fraction: do we still needan implantable cardioverter-defibrillator for primary prevention?

Sudden death is a devastating complication of heart failure (HF). Current guidelines recommend an implantable cardioverter-defibrillator (ICD) for prevention of sudden death in patients with HF and reduced ejection fraction (HFrEF) specifically those with a left ventricular ejection fraction ≤35% after at least 3 months of optimized HF treatment. The benefit of ICD in patients with symptomatic HFrEF caused by coronary artery disease has been well documented; however, the evidence for a benefit of prophylactic ICD implantation in patients with HFrEF of non-ischaemic aetiology is less strong. Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers (BB), and mineralocorticoid receptor antagonists (MRA) block the deleterious actions of angiotensin II, norepinephrine, and aldosterone, respectively. Neprilysin inhibition potentiates the actions of endogenous natriuretic peptides that mitigate adverse ventricular remodelling. BB, MRA, angiotensin receptor-neprilysin inhibitor (ARNI) have a favourable effect on reduction of sudden cardiac death in HFrEF. Recent data suggest a beneficial effect of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in reducing serious ventricular arrhythmias and sudden cardiac death in patients with HFrEF. So, in the current era of new drugs for HFrEF and with the optimal use of disease-modifying therapies (BB, MRA, ARNI and SGLT2i), we might need to reconsider the need and timing for use of ICD as primary prevention of sudden death, especially in HF of non-ischaemic aetiology.

A Multicenter External Validation of a Score Model to Predict Risk of Events in Patients With Brugada Syndrome

A multivariate risk score model was proposed by Sieira et al in 2017 for sudden death in Brugada syndrome; their validation in 150 patients was highly encouraging, with a C-index of 0.81; however, this score is yet to be validated by an independent group. A total of 192 records of patients with Brugada syndrome were collected from 2 centers in the United Kingdom and retrospectively scored according to a score model by Sieira et al. Data were compiled summatively over follow-up to mimic regular risk re-evaluation as per current guidelines. Sudden cardiac death survivor data were considered perievent to ascertain the utility of the score before cardiac arrest. Scores were compared with actual outcomes. Sensitivity in our cohort was 22.7%, specificity was 57.6%, and C-index was 0.58. In conclusion, up to 75% of cardiac arrest survivors in this cohort would not have been offered a defibrillator if evaluated before their event. This casts doubt on the utility of the score model for primary prevention of sudden death. Inherent issues with modern risk scoring strategies decrease the likelihood of success even in robustly designed tools such as the Sieira score model.

Severity of spleep apnea syndrome and life-threatening tachyarrhythmias in patients with implantable cardioverter defibrillator.

Sleep apnea syndrome (SAS) has been reported to be associated with a higher incidence of ventricular arrhythmias. The aim of this study was twofold: (1) to investigate whether in SAS patients receiving an implantable cardioverter defibrillator (ICD) the severity of SAS was associated with the occurrence of ventricular arrhythmias; (2) to assess whether changes in nocturnal apnoic/hypopnoic episodes may favor the occurrence of life-threatening arrhythmias, that is, sustained ventricular tachycardia (VT)/fibrillation (VF), requiring ICD intervention. We enrolled 46 patients with documented SAS at polysomnography (apnea/hypopnea index [AHI]>5) who also had a left ventricle ejection fraction (LVEF)<35% and, according to primary prevention indications, implanted an ICD (Boston Scientific Incepta) able to daily monitor apnoic/hypopnoic episodes occurring during sleep. Patients were followed at 3-month intervals. At a mean follow-up of 18 months, 21 episodes of sustained VT/FV requiring ICD intervention were documented in eight patients (17.4%). Baseline AHI was significantly higher in patients with compared to those without ICD intervention. ICD interventions, however, were not preceded by any worsening of apnoic/hypopnoic episodes. The respiratory disturbance index (RDI) of the week during the event, indeed, was not different from that recorded during the previous 2weeks (25.4 ± 11, 25.6 ± 10 and 25.1 ± 10, respectively; p=.9). In patients with SAS who received an ICD for primary prevention of sudden death, those with ICD interventions showed a more severe form of the disease at baseline. ICD interventions, however, were not preceded by any significant changes in SAS severity.

Abstract 16148: Serum Gdf-15 Identifies Patients at Risk for Acute Heart Failure but Not Ventricular Arrhythmias and Sudden Death

Introduction: GDF-15 (Growth Differentiation Factor 15), a member of the transforming growth factor beta superfamily, has been shown to be a biomarker of mitochondrial diseases. Additionally, increased levels of GDF-15 have also been associated with all-cause death and heart failure (HF) in patients with coronary artery disease. Conflicting data exists regarding GDF-15 levels and risk of ventricular arrhythmic events. Hypothesis: In a cohort of patients with reduced left ventricular systolic function, GDF-15 identifies patients at high risk of (1) worsening HF and (2) sudden arrhythmic death. Methods: PROSe-ICD is a multicenter prospective cohort study of 1,189 patients with ischemic and non-ischemic cardiomyopathy who underwent ICD implantation for primary prevention of sudden death, designed to compare patients who sustain an appropriate ICD firing for rapid VT or VF (surrogate for sudden death) to those who do not. Worsening HF was defined as any admission for acute decompensated HF during an average follow up period of 8 years. Blood samples were obtained on average every 6 months and GDF-15 was measured with an ELISA based assay from a subset of PROSe-ICD patients with appropriate ICD shocks (n=58; 228 samples), worsening HF (n=42; 157 samples), both HF and VT/VF (n=12; 46 samples) and 237 samples from 46 controls without ICD shocks and HF, matched for age and ejection fraction. Results: GDF-15 levels were elevated in patients who had acute decompensated heart failure, but not in patients who experienced ICD shocks in the absence of worsening HF (see Figure). Differences in GDF-15 levels were relatively stable over time within individual patients, and did not predict HF events. Conclusions: Future studies need to examine whether patients with the highest GDF-15 levels have underlying mitochondrial or nuclear DNA mutations leading to mitochondrial dysfunction and worsening HF.

Abstract 17215: Differences in Anatomy, Physiology and Outcomes Between Blacks and Whites With Hypertrophic Cardiomyopathy

Introduction: Hypertrophic cardiomyopathy (HCM) in Black populations remains underexplored even though this inherited disorder can affect more than 220,000 Blacks in the US alone. Existing data suggest that Blacks with HCM are less likely to have obstructive physiology, but uncommon phenotypes, such as mid-ventricular obstruction have not been reported. Mortality outcomes have been reported as similar between groups. Objective: To evaluate structural HCM features and outcomes in Blacks and Whites with HCM Methods: The study design was a retrospective analysis of a prospective longitudinal observational study of a referred patient population with confirmed HCM and self-identifying as Black/African American and White/Caucasian. Results: We studied 434 individuals, 57 (13.1%) were Black. Males were 52.6% of the Black cohort and 59% of the White cohort. Blacks were younger, mean (SD) 54.6 (13.4) vs 62.6 (14.8) years, p&lt;0.001. Ejection fraction and left ventricular hypertrophy (LVH) magnitude were similar between groups but LVH distribution differed with Blacks having more sub-basal LVH, which includes apical, apical-mid and mid LVH, 22 (38.6%) vs 56 (14.9%), p&lt;0.001, and diffuse LVH, 6 (10.5%) vs 15 (4.0%), p=0.017, than Whites. Blacks also had more mid-ventricular obstruction, 7 (12.3%) vs 21 (5.5%), p=0.025. Of those who had a cardiac MRI, Blacks had more significant fibrosis (≥15% of LV mass), 10 (30.3%) vs 20 (9.5%), p&lt;0.001. Mortality was low overall and both groups had similar proportion of ICD insertion for primary prevention of sudden death. However, Blacks had more appropriate ICD interventions, 5 (38.5%) vs 5 (6.8%), p=0.001. Conclusions: Blacks with HCM have more sub-basal LVH and mid-ventricular obstruction than Whites with HCM, phenotypes associated with worse disease progression. They are more likely to have significant myocardial fibrosis which has a pro-arrhythmic effect. They also had more aborted sudden death events. Precise evaluation of HCM structural and physiologic characteristics can improve targeted treatment and outcomes in this population.

Results of the First SAC Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy Registry (RENCARE)

Background: Prevention of sudden death and treatment of heart failure are very important topics. Implantable cardioverterdefibrillatorand cardiac resynchronization devices are used to prevent sudden death and improve heart failure symptomsand prognosis.Objectives: The aim of this study was to evaluate the number, type of implanted devices, clinical characteristics of the patientsand acute and follow-up complications.Methods: An observational, prospective, multicenter study was carried out in healthcare centers with the capacity to implantcardioverter-defibrillator and cardiac resynchronization devices. The study included all patients who underwent implantationof these devices from January 2016 to January 2017, with a 12-month follow-up.Results: A total of 249 patients (73.9% men) with mean age of 64.8±13.7 years, and 72.1% with ejection fraction <35%, wereincluded in the study. The underlying cardiomyopathy etiology was ischemic in 39.8% of cases, dilated in 26.7% and chagasicin 11.2%. Fifty-eight percent of implants were implantable cardioverter-defibrillators and 39% were cardioverter-defibrillatorsassociated with cardiac resynchronization devices. In 84% of cases, procedures were first implants. The most frequent indicationof implantation was for primary prevention of sudden death (67.9%). Minor complication rate was 4.4% and no majorcomplications were reported.Conclusions: The present registry evidenced a large proportion of cardioverter-defibrillator and cardiac resynchronizationimplants in patients with ischemic heart disease. The main indication was for primary prevention of sudden death and thecomplication rate was similar to that reported internationally.

Results of the First SAC Implantable Cardioverter-Defibrillator and Cardiac Resynchronization Therapy Registry (RENCARE)

Background: Prevention of sudden death and treatment of heart failure are very important topics. Implantable cardioverterdefibrillatorand cardiac resynchronization devices are used to prevent sudden death and improve heart failure symptomsand prognosis.Objectives: The aim of this study was to evaluate the number, type of implanted devices, clinical characteristics of the patientsand acute and follow-up complications.Methods: An observational, prospective, multicenter study was carried out in healthcare centers with the capacity to implantcardioverter-defibrillator and cardiac resynchronization devices. The study included all patients who underwent implantationof these devices from January 2016 to January 2017, with a 12-month follow-up.Results: A total of 249 patients (73.9% men) with mean age of 64.8±13.7 years, and 72.1% with ejection fraction <35%, wereincluded in the study. The underlying cardiomyopathy etiology was ischemic in 39.8% of cases, dilated in 26.7% and chagasicin 11.2%. Fifty-eight percent of implants were implantable cardioverter-defibrillators and 39% were cardioverter-defibrillatorsassociated with cardiac resynchronization devices. In 84% of cases, procedures were first implants. The most frequent indicationof implantation was for primary prevention of sudden death (67.9%). Minor complication rate was 4.4% and no majorcomplications were reported.Conclusions: The present registry evidenced a large proportion of cardioverter-defibrillator and cardiac resynchronizationimplants in patients with ischemic heart disease. The main indication was for primary prevention of sudden death and thecomplication rate was similar to that reported internationally.

Sport activity in patients with cardiac implantable electronic devices: evidence and perspectives.

Demographic characteristics of patients with cardiac implantable electronic devices have significantly changed during the last few years, according to the ageing of the population and the consequent increase in the number of elderly individuals with indication for pacemaker implant and, on the other hand, to the increased number of young individuals implanted with an implantable cardioverter defibrillator for the primary prevention of sudden death. More and more often, both elderly and young patients ask the physician to deal with the device in their daily activities, which often include sport practice. This latter is advisable because of its recognized benefits on cardiovascular prevention, although there are many limitations for patients with a cardiac implantable electronic device. Hence, the need to balance the patient's request with the appropriate precautions emerging from existing evidence. The current article aims to provide an overview of the most recent data on this topic, derived from registries and observational studies. Over the years an attempt to standardize recommendations has been made, but robust evidence is still lacking. Substantial differences exist between countries based on their sports regulations. Official recommendations of European and American Scientific Societies are resumed. The future perspective is to obtain data to allow these patients a safer practice of sport activity also through technological advances in terms of device materials and programming improvement and the possibility of remote monitoring.

P1149Subcutaneous implantable cardioverter-defibrillator when Transvenous ICD is not a viable option

Abstract Funding Acknowledgements NO FUNDING OnBehalf RHYTHM DETECT Registry Background The class of recommendation for S-ICD implantation in patients who have inadequate vascular access is I according to AHA-ACC-HRS Guidelines and IIb according to ESC Guidelines. Data are lacking about the use of S-ICD for patients in which a transvenous ICD is not a viable option because of the inability to deploy a transvenous lead. Purpose To describe current practice and to measure outcomes associated with S-ICD use in patients in which a transvenous ICD is not a viable option. Methods 942 consecutive patients underwent S-ICD implantation at 22 Italian centers from 2014 to 2019. We identified 101 (11%) patients who received S-ICD because of the reported impossibility of deploying a transvenous lead. Results 21 patients presented with inadequate vascular access but no previous device in place. One patient had a mechanical prosthesis in tricuspid position. The remaining 79 patients received the S-ICD after removal of a prior system implanted, and venous occlusion was diagnosed after lead extraction, or partially or completely failed lead removal. In 24 of these patients a functional transvenous pacing system was left in place for persisting pacing needs. Patients were 60 ± 15 years old, 85% were male, 77% had ischemic or non-ischemic dilated cardiomyopathy, ejection fraction was 36 ± 13%. At implantation, acute conversion test was performed in 64 patients and shock energy of ≤65J was successful in 62 (96.9%) patients. During a median follow-up of 18 months, 6 patients died for non-device related reasons and 1 patient underwent heart transplantation. One patient underwent device replacement for battery depletion and one patient underwent leadless pacemaker implantation. Minor complications (hematomas not requiring system revision) were reported in 2 patients. Appropriate therapies were delivered in 4 patients and 8 patients experienced inappropriate therapies (in 3 patients due to double counting during pacing); all resolved with device reprogramming. Conclusions: In current clinical practice, a minority of S-ICD patients receive the device because of inadequate vascular access. The profile of these patients is similar to that of the typical ICD population in the context of primary sudden death prevention, but many of them present with pacing indications. Acute and mid-term efficacy of S-ICD seemed high. Few complications occurred during follow-up. Particular attention must be paid to device programming for those patients with concomitant pacing systems, in order to prevent inappropriate therapies.

“MZ was here!” The importance of an implantable cardioverter-defibrillator monitoring zone in the primary prevention of sudden death

“MZ was here!” The importance of an implantable cardioverter-defibrillator monitoring zone in the primary prevention of sudden death

“MZ was here!” The importance of an implantable cardioverter-defibrillator monitoring zone in the primary prevention of sudden death

“MZ was here!” The importance of an implantable cardioverter-defibrillator monitoring zone in the primary prevention of sudden death

Echocardiography in Athletes in Primary Prevention of Sudden Death.

Echocardiography is a noninvasive imaging technique useful to provide clinical data regarding physiological adaptations of athlete's heart. Echocardiographic characteristics may be helpful for the clinicians to identify structural cardiac disease, responsible of sudden death during sport activities. The application of echocardiography in preparticipation screening might be essential: it shows high sensitivity and specificity for identification of structural cardiac disease and it is the first-line imagining technique for primary prevention of SCD in athletes. Moreover, new echocardiographic techniques distinguish extreme sport cardiac remodeling from beginning state of cardiomyopathy, as hypertrophic or dilated cardiomyopathy and arrhythmogenic right ventricle dysplasia. The aim of this paper is to review the scientific literature and the clinical knowledge about athlete's heart and main structural heart disease and to describe the rule of echocardiography in primary prevention of SCD in athletes.

346 - Safety of ICD Implant in LVAD Patients

Background: Although the role of intracardiac defibrillators (ICDs) in primary prevention of sudden death in patients with left ventricular assist devices (LVADs) remains questionable, many LVAD patients continue to undergo ICD implant. Moreover, data on bleeding complications related to ICD insertion in this high-risk population have are lacking. Methods: Retrospective single center study of patients supported with a CF-LVAD who underwent ICD implantation (Group1 = 20) were compared to 100 LVAD patients (Group2: controls with ICDs). Baseline characteristics, post procedural bleeding complications, length of stay, in hospital and 30 day mortality and length of stay were assessed. Results: Group 1 patients were more likely to be younger (42.7 ± 12 vs. 52.29 ± 14, P = .006) and less likely to have HTN or diabetes. Mean INR at time of ICD implant was 2.35 ± 0.46. Among patients who underwent ICD implant, 63 % of ICDs were performed on same admission as LVAD insertion. Major bleeding were very low (9%). No difference in in hospital or 30 day mortality was noticed between the 2 groups. Similarly, no significant difference in LOS were observed. Conclusion: ICD implantation in patients with CF-LVADS appears to be safe and is associated with low a risk of bleeding with no significant increase in length of stay.

4786Discordance between the criteria for ICD implantation in the primary prevention of sudden death among patients with hypertrophic cardiomyopathy

4786Discordance between the criteria for ICD implantation in the primary prevention of sudden death among patients with hypertrophic cardiomyopathy