Predictors of appropriate ICD therapy in patients with implantable cardioverter-defibrillator

Abstract

Background: Understanding the predictors of appropriate implantable cardioverter defibrillator (ICD) therapy could help to better identify candidates for ICD implantation. Methods: One hundred and sixty two patients with ICD (111 with coronary artery disease [CAD] and 51 with dilated cardiomyopathy [DCM]) were included in the study. Clinical, electrocardiographic, and ICD stored data and electrograms were collected. Results: During mean follow up of 15±11 months 54 patients (33%) received ≥ 1 appropriate ICD therapy (AICDT). We used binary logistic regression analysis with forward selection method to find the potential predictors of appropriate ICD therapy after device implantation. Male gender (odds ratio [OR] = 2.76, 95% confidence interval [CI] = 1.1 – 7.1, P=0.021), DCM as underlying heart disease (OR = 4.2, 95% CI = 1.9 – 9.5, P=0.001), and QRS width > 100 ms (OR = 2.58, 95% CI = 1.2 – 5.4, P=0.010) were correlated with increased likelihood of AICDT during the follow up period. In subgroup analysis of the patients with CAD and DCM, QRS duration > 100 ms was correlated with the probability of ≥ 1 AICDT. In our patients indication of ICD implantation (primary versus secondary prevention) did not influence probability of ≥ 1 AICDT (adjusted OR = 1.66, 95% CI = 0.7 – 4.0, Mantel-Haenszel P value P=0.355.) Conclusion: QRS width could be used as an additional simple risk stratifier beyond EF to identify potential candidates who would benefit more from ICD implantation. This may have practical implications for patient selection especially in developing countries. Indication of ICD implantation (primary versus secondary prevention) did not affect the probability of ≥ 1 AICDT during the follow up period.

Keywords

• Implantable cardioverter-defibrillator
• Appropriate ICD therapy
• Coronary artery disease
• Dilated cardiomyopathy