Abstract 12820: Arrhythmias on Home Intravenous Inotropic Therapy in Advanced Heart Failure
Introduction: Although home inotropes improve hemodynamics and symptoms in low-output congestive heart failure (CHF), they were associated with arrhythmias in prior trials. However, these studies were performed before routine use of implantable cardioverter defibrillators (ICDs), cardiac resynchronization, beta blockers, and aldosterone antagonists in CHF. Although concern for arrhythmias limits inotrope use, arrhythmia risks with inotropes on modern therapies are not well known.
Methods: We collected arrhythmia data at baseline and post-inotrope on 197 consecutive patients discharged from our institution between January 2007 and March 2013 on intravenous inotropes. Patients were followed until they died, received a transplant or left ventricular assist device, were weaned off inotropes, or remained on inotropes at the end of the study.
Results: All patients had advanced CHF, with mean baseline NYHA 3.7, cardiac index 1.7 L/min/m2, left ventricular ejection fraction (LVEF) 17%. At baseline, 39% had a history of atrial fibrillation (AF), 30% had documented history of ventricular tachycardia (VT), and 7.1 % had a prior cardiac arrest. Milrinone was used in 85% and dobutamine in 15%.
During follow-up, 33 patients (16.7%) had one or more ICD shocks, of which 27 (82%) had appropriate shocks for VT/VF, 3 (9%) had inappropriate shocks, and 3 (9%) had both appropriate and inappropriate shocks. LVEF, history of VT/VF, and ACE inhibitor use were associated with ICD shocks by logistic regression. Cardiomyopathy etiology, inotrope type or dose, and beta-blocker use did not correlate with ICD shocks.
Of 184 subjects who had data for AF pre- and post-inotrope, 72 (39.1%) had history of AF pre-inotrope. Of these, 49 (68.1%) continued to have AF post-inotrope. Of the 112 patients without AF prior to inotropes, 13 (11.6%) developed new AF on inotropes. Pre-inotrope history of AF and pulmonary vascular resistance were predictors of post-inotrope arrhythmia, defined as AF or ICD shocks
Conclusions: Arrhythmias in patients with CHF may be exacerbated by inotropes, but occur in a minority of patients. Inotropes have a role in selected patients with severe CHF despite arrhythmic risks, and ICDs provide appropriate therapy for malignant arrhythmias in most cases.
Author Disclosures: K. Sanam: None. M.I. Revilla Martinez: None. T. Hashim: None. C.J. Morgan: None. J.A. Tallaj: None. S.V. Pamboukian: None. R.Y. Loyaga-Rendon: None. J.F. George: None. D. Acharya: None.
- © 2014 by American Heart Association, Inc.