[Factors predisposing to the reprogramming of implantable cardioverter-defibrillators and the causes of changes in pharmacotherapy in patients with dilated cardiomyopathy for primary prevention of sudden cardiac death]

Joanna Pudło, Piotr Liszniański, Tomasz Senderek, Maria Lelakowska-Pieła, Jacek Lelakowski, Jacek Nowak
Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego 2015, 39 (230): 86-90

UNLABELLED: Ambulatory care of patients with implantable cardioverter-defibrillator (ICD) involves regular follow-up visit, where a decision on reprogramming of the device and modification of pharmacotherapy is made.

AIM: The aim of the study was the assessment of frequency and reasons of reprogramming and pharmacotherapy changes in patients with dilated cardiomyopathy with an ICD implanted due to primary prevention of sudden cardiac death (SCD).

MATERIALS AND METHODS: The study included 143 consecutive patients with an ICD implanted in 2010-2011. The inclusion criteria were: left ventricle ejection fraction (LVEF)≤35%, New York Heart Association (NYHA) Class≥II, implantation due to primary prevention of SCD. All ambulatory visits in outpatient department were investigated retrospectively. The following variables were analyzed: age, gender, presence of coronary artery disease (CAD) and atrial fibrillation (AF), LVEF, NYHA class, presence of interventions, reprogramming and pharmacotherapy changes.

RESULTS: The most common changes in ICD parameters were modification of detection and therapy of ventricular arrhythmias. Modification of pharmacotherapy were most often referred to B-blocker and cardiac glycosides. Patients with AF had more often parameters of bradycardia pacing changed (p=0,016). There was a significant correlation between number of interventions and total number of reprogramming (r=0,3 p<0,05). A negative correlation was found between LVEF and number of reprogramming of detection of ventricular tachyarrhythmia (r=-0,18 p<0,05) and between LVEF and number of interventions (r=-0,2, p<0,05). Patients with interventions and patients AF had more pharmacotherapy changes (82 vs 29, p<0,001 and 59 vs 52, p<0,01 respectively). A significant correlation was found between number of interventions and total number of pharmacotherapy changes (r=0,5 p<0,05) and between number of interventions and modification of pharmacotherapy with B-blocker, cardiac glycosides and introduction of amiodarone therapy (r=0,47; r=0,30; r=0,32 respectively, p<0,05).

CONCLUSIONS: Patients with AF had more changes in ICD parameters, pacing parameters and pharmacotherapy. Patients with lower LVEF had more interventions and more changes in detection of ventricular tachyarrhythmia.

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