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European Heart Journal Advance Access originally published online on June 2, 2009
European Heart Journal 2009 30(13):1621-1626; doi:10.1093/eurheartj/ehp234
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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

Recurrence of ventricular arrhythmias in ischaemic secondary prevention implantable cardioverter defibrillator recipients: long-term follow-up of the Leiden out-of-hospital cardiac arrest study (LOHCAT)

C. Jan Willem Borleffs1, Lieselot van Erven1, Martje Schotman1, Eric Boersma2, Philippine Kiès1, Alida E. Borger van der Burg1, Katja Zeppenfeld1, Marianne Bootsma1, Ernst E. van der Wall1, Jeroen J. Bax1 and Martin J. Schalij1,*

1 Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, PO Box 9600, 2300 RC Leiden, Leiden, The Netherlands
2 Department of Clinical Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands

Received 14 January 2009; revised 14 April 2009; accepted 11 May 2009; online publish-ahead-of-print 2 June 2009.

* Corresponding author. Tel: +31 71 526 2020, Fax: +31 71 526 6809, Email: m.j.schalij{at}lumc.nl

See page 1551 for the editorial comment on this article (doi:10.1093/eurheartj/ehp217)

Aims: To assess the long-term rate of mortality and the recurrence of potentially life-threatening ventricular arrhythmias in secondary prevention implantable cardioverter defibrillator (ICD) patients and to construct a model for baseline risk stratification.

Methods and results: Since 1996, all patients with ischaemic heart disease, receiving ICD therapy for secondary prevention of sudden death, were included in the current study. Patients were evaluated at implantation and during long-term follow-up. A total of 456 patients were included in the analysis and followed for 54 ± 35 months. During follow-up, 100 (22%) patients died and ICD therapy was noted in 216 (47%) patients, of which 138 (30%) for fast, potentially life-threatening ventricular arrhythmia. Multivariate analysis revealed a history of atrial fibrillation or flutter (AF), ventricular tachycardia as presenting arrhythmia, and wide QRS and poor left ventricular ejection fraction as independent predictors of life-threatening ventricular arrhythmias. The strongest predictor was AF with a hazard ratio of 2.1 (95% confidence interval 1.3–3.2). On the basis of the available clinical data, it was not possible to identify a group which exhibited no risk on recurrence of potentially life-threatening ventricular arrhythmias.

Conclusion: Ischaemic secondary prevention ICD recipients exhibit a high recurrence rate of potentially life-threatening ventricular arrhythmias. Factors that increase risk can be identified but, even with these factors, it was not possible to distinguish a recurrence-free group.

Key Words: Implantable cardioverter defibrillator • Ischaemic heart disease • Ventricular arrhythmia • Sudden death • Secondary prevention


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