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European Heart Journal Advance Access originally published online on March 4, 2009
European Heart Journal 2009 30(10):1237-1244; doi:10.1093/eurheartj/ehp071
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Incidence and prognostic significance of sustained ventricular tachycardias in heart failure patients implanted with biventricular pacemakers without a back-up defibrillator: results from the prospective, multicentre, Mona Lisa cohort study

Serge Boveda1, Eloi Marijon1,*, Sophie Jacob2, Pascal Defaye3, Jobst B. Winter4, Alan Bulava5, Daniel Gras6, Jean Paul Albenque1, Nicolas Combes1, Dominique Pavin7, Nicolas Delarche8, Alexander Teubl9, Marie Lambiez10, Philippe Chevalier11 on behalf of the Mona Lisa Study Group

1 Clinique Pasteur, Département de Rythmologie, Toulouse, France
2 IRSN, Laboratoire d'Epidémiologie, Fontenay-aux-Roses, France
3 Centre Hospitalo-Universitaire, Grenoble, France
4 Twee Steden Ziekenhuis, Tilburg, The Netherlands
5 University Hospital, Olomouc, Czech Republic
6 Nouvelles Cliniques Nantaises, Nantes, France
7 Centre Hospitalo-Universitaire, Rennes, France
8 Hôpital Général, Pau, France
9 KH Wiener Neustadt, Austria
10 Guidant, Montigny le Bretonneux, France
11 Université de Lyon, F-69008, Lyon, France; Université Lyon 1, Faculté de Médecine Lyon Est; Hospices Civils de Lyon, Hôpital Louis Pradel, Service de Rythmologie, F-69677, Bron, France

Received 9 September 2008; revised 10 January 2009; accepted 30 January 2009; online publish-ahead-of-print 4 March 2009.

* Corresponding author. Département de Rythmologie, Clinique Pasteur, 43-45 avenue de Lombez, 31076 Toulouse, BP 27617 Cedex 3, France. Tel: +33 5 62 21 16 45, Fax: +33 5 62 21 16 41, Email: eloi_marijon{at}yahoo.fr

Aims: The aim of this study was to investigate the 12-month incidence, predictive factors, and prognosis of sustained ventricular tachycardia (VT) in chronic heart failure patients implanted with biventricular pacemakers without a back-up defibrillator (CRT-P), assessed by continuous intracardiac ventricular electrograms.

Methods and results: The Mona Lisa study, a prospective, multicentre, cohort study, designed to determine the incidence of sustained VT and its prognostic impact in CRT-P recipients within the year after implant enrolled 198 patients with moderate or severe chronic heart failure, despite optimal pharmacological therapy. An independent committee reviewed the data from all arrhythmic episodes as well as causes of death according to predefined criteria. During a mean follow-up of 9.8 ± 3.1 months after implantation, 8 patients experienced at least one episode of sustained VT [4.3%; 95% confidence interval (CI), 1.1–7.5] and 21 deaths occurred, giving a 12-month mortality rate of 11.7% (95% CI, 6.4–16.9). The presence of sustained VT was associated with a high risk of sudden cardiac death (SCD) and the lowest 12-month overall survival (P < 0.0001).

Conclusion: The incidence of sustained VT remains relatively low in the first year after CRT-P implantation, but when present appears closely associated with short-term adverse outcomes, especially SCD. This emphasizes the possible value of remote monitoring to detect high-risk patients for urgent upgrading.

Key Words: Heart failure • Ventricular tachycardia • Cardiac resynchronization therapy • Incidence • Electrograms


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