Long-term outcomes among a nationwide cohort of patients using an implantable cardioverter-defibrillator : UMBRELLA study final results
Briongos-Figuero, S. (Universidad Complutense de Madrid)
García-Alberola, A. (Hospital Universitario Virgen de la Arrixaca (Múrcia))
Rubio, J. (Hospital Clínico Universitario de Valladolid)
Segura, J. M. (Hospital Universitario Reina Sofía (Còrdova, Espanya))
Rodríguez, A. (Hospital Universitario de Canarias (La Laguna))
Peinado, R. (Hospital Universitario La Paz (Madrid))
Alzueta, Javier (Hospital Universitario Virgen de la Victoria (Màlaga, Andalusia))
Martínez-Ferrer, José Bautista (Arabako Unibertsitate Ospitalea (Vitoria, País Basc))
Viñolas, Xavier (Institut d'Investigació Biomèdica Sant Pau)
De La Concha, J.F. (Hospital Infanta Cristina)
Anguera, Ignasi (Hospital Universitari de Bellvitge)
Martín, M. (Medtronic Ibérica)
Cerdá, L. (Medtronic Ibérica)
Pérez, L. (Complejo Hospitalario Universitario de A Coruña)

Data:	2021
Resum:	BACKGROUND: Large-scale studies describing modern populations using an implantable cardioverter-defibrillator (ICD) are lacking. We aimed to analyze the incidence of arrhythmia, device interventions, and mortality in a broad spectrum of real-world ICD patients with different heart disorders. METHODS AND RESULTS: The UMBRELLA study is a prospective, multicenter, nationwide study of contemporary patients using an ICD followed up by remote monitoring, with a blinded review of arrhythmic episodes. From November 2005 to November 2017, 4296 patients were followed up. After 46. 6±27. 3 months, 16 067 episodes of sustained ventricular arrhythmia occurred in 1344 patients (31. 3%). Appropriate ICD therapy occurred in 27. 3% of study population. Patients with ischemic cardiomyopathy (hazard ratio [HR], 1. 51; 95% CI, 1. 29-1. 78), dilated cardiomyopathy (HR, 1. 28; 95% CI, 1. 07-1. 53), and valvular heart disease (HR, 1. 94; 95% CI, 1. 43-2. 62) exhibited a higher risk of appropriate ICD therapies, whereas patients with hypertrophic cardiomyopathy (HR, 0. 72; 95% CI, 0. 54-0. 96) and Brugada syndrome (HR, 0. 25; 95% CI, 0. 14-0. 45) showed a lower risk. All-cause death was 13. 4% at follow-up. Ischemic cardiomyopathy (HR, 3. 09; 95% CI, 2. 58-5. 90), dilated cardiomyopathy (HR, 3. 33; 95% CI, 2. 18-5. 10), and valvular heart disease (HR, 3. 97; 95% CI, 2. 25-6. 99) had the worst prognoses. Delayed high-rate detection was enabled in 39. 7% of patients, and single-zone programming occurred in 52. 6% of primary prevention patients. Both parameters correlated with lower risk of first appropriate ICD therapy, with no excess risk of mortality. The rate of inappropriate shocks at follow-up was low (6%) and did not differ among type of ICD but was lower in SmartShock-capable devices. CONCLUSIONS: Irrespective of the cause, contemporary ICD patients with heart failure-related disorders had a similar risk of ICD life-saving interventions and death. Current ICD programming recommendations still need to be implemented.
Nota:	Altres ajuts: Medtronic Iberica.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	All-cause death ; Appropriate implantable cardioverter-defibrillator therapy ; Implantable cardioverter-defibrillator ; Inappropriate shock ; Sustained ventricular arrhythmia
Publicat a:	Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol. 10 Núm. 1 (may 2021) , p. 1-23, ISSN 2047-9980

DOI: 10.1161/JAHA.120.018108
PMID: 33356406

23 p, 936.9 KB

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