Published online before print June 12, 2006, doi: 10.1161/CIRCULATIONAHA.105.577262
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2006;113:2810-2817.)
© 2006 American Heart Association, Inc.
Heart Failure |
Causes and Consequences of Heart Failure After Prophylactic Implantation of a Defibrillator in the Multicenter Automatic Defibrillator Implantation Trial II
From the Cardiology Unit of the Department of Medicine (I.G., A.J.M., S.M., W.Z., M.L.A.) and the Department of Biostatistics and Computational Biology (W.J.H.), University of Rochester Medical Center, Rochester, NY, and Cardiology Associates (D.S.C.), Good Samaritan Hospital, Los Angeles, Calif.
Correspondence to Ilan Goldenberg, MD, Heart Research Follow-up Program, Box 653, University of Rochester Medical Center, Rochester, NY 14642. E-mail Ilan.Goldenberg{at}heart.rochester.edu
Received July 20, 2005; revision received March 17, 2006; accepted April 7, 2006.
Background— Implantable cardioverter-defibrillator (ICD) therapy may be associated with an increased risk for heart failure (HF). The present study evaluated the frequency, causes, and consequences of HF after ICD implantation.
Methods and Results— We performed a retrospective analysis of the clinical factors and outcomes associated with postenrollment HF events in 1218 patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial II. The adjusted hazard ratios (HRs) of ICD:conventional therapy for first and recurrent HF events were 1.39 (P=0.02) and 1.58 (P<0.001), respectively. The risk was increased among patients who received single-chamber or dual-chamber ICDs. Development of HF was associated with an increased mortality risk (HR, 3.80; P<0.001). Among patients who received a single-chamber ICD, there was a similar survival benefit before and after the development of HF (HR, 0.59 and 0.61, respectively; P=0.92 for difference), whereas among patients with dual-chamber devices, there was a significant reduction in survival benefit after HF (HR, 0.26 and 0.83, respectively; P=0.01 for difference). Within the defibrillator arm of the trial, patients who received life-prolonging therapy from the ICD had an increased risk for first and recurrent HF events (HR, 1.90; P=0.01 and 1.74; P<0.001, respectively).
Conclusions— Patients with chronic ischemic heart disease who are treated with either single-chamber or dual-chamber ICDs have improved survival but an increased risk of HF. The present data suggest that ICD therapy transforms sudden death risk to a subsequent HF risk. These findings should direct more attention to the prevention of HF in patients who receive an ICD.
CLINICAL PERSPECTIVE
This article has been cited by other articles:
 |
|
 |
|
  J. G F Cleland, A. Tageldien, N. Maarouf, and N. Hobson Patients with heart failure who require an implantable defibrillator should have cardiac resynchronisation routinely Heart, August 1, 2008; 94(8): 963 - 966. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Ding, W. Hua, H. Niu, K. Chen, and S. Zhang Primary prevention of sudden cardiac death using implantable cardioverter defibrillators Europace, June 16, 2008; (2008) eun150v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. O. Sweeney and F. W. Prinzen Ventricular Pump Function and Pacing: Physiological and Clinical Integration Circ Arrhythmia Electrophysiol, June 1, 2008; 1(2): 127 - 139. [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Moss Life Versus Death Circulation, April 15, 2008; 117(15): 1912 - 1913. [Full Text] [PDF]
|
|
|
|
|
|
M. T. Koller, B. Schaer, M. Wolbers, C. Sticherling, H. C. Bucher, and S. Osswald Death Without Prior Appropriate Implantable Cardioverter-Defibrillator Therapy: A Competing Risk Study Circulation, April 15, 2008; 117(15): 1918 - 1926. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Zannad, W. G. Stough, B. Pitt, J. G.F. Cleland, K. F. Adams, N. L. Geller, C. Torp-Pedersen, B.-A. Kirwan, and F. Follath Heart failure as an endpoint in heart failure and non-heart failure cardiovascular clinical trials: the need for a consensus definition Eur. Heart J., February 1, 2008; 29(3): 413 - 421. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Matlock Implantable Cardioverter-Defibrillators, Heart Failure, and Patient Characteristics JAMA, January 23, 2008; 299(3): 285 - 286. [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Ezekowitz, B. H. Rowe, D. M. Dryden, N. Hooton, B. Vandermeer, C. Spooner, and F. A. McAlister Systematic Review: Implantable Cardioverter Defibrillators for Adults with Left Ventricular Systolic Dysfunction Ann Intern Med, August 21, 2007; 147(4): 251 - 262. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. S. Chugh, K. Reinier, and E. C. Stecker Learning From a Real-World Analysis of Implantable Cardioverter-Defibrillator Recipients: Comorbidities Matter J. Am. Coll. Cardiol., June 26, 2007; 49(25): 2416 - 2418. [Full Text] [PDF]
|
|
|
|
|
|
D. S. Lee, J. V. Tu, P. C. Austin, P. Dorian, R. Yee, A. Chong, D. A. Alter, and A. Laupacis Effect of Cardiac and Noncardiac Conditions on Survival After Defibrillator Implantation J. Am. Coll. Cardiol., June 26, 2007; 49(25): 2408 - 2415. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Kloner and D. S. Cannom Uncertainty on the Use of Aldosterone Antagonists for Primary Therapy for Sudden Cardiac Death in the Setting of Implanted Devices Circulation, June 12, 2007; 115(23): 2983 - 2989. [Full Text] [PDF]
|
|
|
|
|
|
T. J. Bunch, S. H. Hohnloser, and B. J. Gersh Mechanisms of Sudden Cardiac Death in Myocardial Infarction Survivors: Insights From the Randomized Trials of Implantable Cardioverter-Defibrillators Circulation, May 8, 2007; 115(18): 2451 - 2457. [Full Text] [PDF]
|
|
|
|
 |
|
 ICD Survival Benefit Comes with Some Risk for Incident Heart Failure Journal Watch Cardiology, July 26, 2006; 2006(726): 3 - 3. [Full Text]
|
|