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| [PMID]: | 28947249 |
| [Au] Autor: | Piccini JP; Sanders P; Shah R; Roberts G; Karst E; Turakhia MP |
| [Ad] Endereço: | Duke University Medical Center, Durham, North Carolina. Electronic address: jonathan.piccini@duke.edu. |
| [Ti] Título: | Impact of Tachyarrhythmia Detection Rate and Time from Detection to Shock on Outcomes in Nationwide US Practice. |
| [So] Source: | Am J Cardiol;120(8):1325-1331, 2017 Oct 15. | | [Is] ISSN: | 1879-1913 |
| [Cp] País de publicação: | United States |
| [La] Idioma: | eng |
| [Ab] Resumo: | Although higher detection rates and delayed detection improve survival in implantable cardioverter defibrillator clinical trials, their effectiveness in clinical practice has limited validation. To evaluate the effectiveness of programming strategies for reducing shocks and mortality, we conducted a nationwide assessment of patients with implantable cardioverter defibrillators or cardiac resynchronization therapy defibrillators with linked remote monitoring data. We categorized patients based on the presence or absence of high rate detection and delayed detection: higher rate delayed detection (HRDD), higher rate early detection (HRED), lower rate delayed detection (LRDD), and lower rate early detection (LRED). Cox regression was used to compare mortality and shock-free survival. There were 64,769 patients (age 68 ± 12 years; 27% female; 46% cardiac resynchronization therapy defibrillator; follow-up 1.7 ± 1.1 years). In the first year, 13% of HRDD, 14% of HRED, 18% of LRDD, and 20% in the LRED group experienced a shock. After adjustment, HRDD was associated with lower risk of shock than HRED (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.89 to 0.98, p = 0.002), LRDD (HR 0.63, 95% CI 0.60 to 0.66, p <0.001), and LRED (HR 0.58, 95% CI 0.55 to 0.61, p <0.001). HRDD was also associated with lower risk of mortality than HRED (adjusted HR 0.80, 95% CI 0.75 to 0.86, p <0.001), LRDD (HR 0.76, 95% CI 0.70 to 0.83, p <0.001), and LRED (HR 0.68, 95% CI 0.62 to 0.73, p <0.001). Similar results were observed in patients with or without a shock in the first 6 months after implant. In conclusion, high rate programming is associated with lower risk of shocks or death compared with delayed detection. Optimal outcomes are observed in patients programmed with both high rate and delayed detection. |
| [Mh] Termos MeSH primário: |
Taquicardia/diagnóstico
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| [Mh] Termos MeSH secundário: |
Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Cardioversão Elétrica/métodos
Seguimentos
Seres Humanos
Incidência
Meia-Idade
Estudos Retrospectivos
Fatores de Risco
Taxa de Sobrevida/tendências
Taquicardia/epidemiologia
Taquicardia/terapia
Fatores de Tempo
Resultado do Tratamento
Estados Unidos/epidemiologia
Adulto Jovem
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| [Pt] Tipo de publicação: | JOURNAL ARTICLE; MULTICENTER STUDY |
| [Em] Mês de entrada: | 1710 |
| [Cu] Atualização por classe: | 171003 |
[Lr] Data última revisão:
| 171003 |
| [Sb] Subgrupo de revista: | AIM; IM |
| [Da] Data de entrada para processamento: | 170927 |
| [St] Status: | MEDLINE |
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