ICD implantation and arrhythmia-free survival in patients with depressed LV function following surgery for valvular heart disease.

摘要

BACKGROUND: Although prophylactic implantable cardioverter-defibrillator (ICD) implantation is beneficial in patients with severe ischemic cardiomyopathy, it is unclear whether patients with cardiomyopathy due to valvular heart disease have a similar benefit. METHODS: We followed 17 patients (14 men/three women, age 62 +/- 13 years, left ventricular ejection fraction [LVEF] 29 +/- 10%) who had nonischemic valvular cardiomyopathy, underwent valvular heart surgery (aortic valve replacement, mitral valve replacement, and/or mitral valve repair), and subsequently had an electrophysiology study (EPS), for a median of 2.8 years. These patients were compared with 34 patients with prior myocardial infarction and no significant valvular heart disease, who were matched (1:2) for age, gender, LVEF, EPS result, T-wave alternans result, and ICD placement. Occurrence of arrhythmias was ascertained from ICD device clinic follow-up and vital status was determined using the National Death Index. RESULTS: There were no differences between the groups in overall survival (P = 0.24) or arrhythmia-free survival (P = 0.38), and the 2-year arrhythmia-free survival was 82% for the valvular patients versus 73% for the ischemic patients. Among patients with ICDs, there was no difference between the groups in overall survival (P = 0.34), time to first appropriate ICD therapy (P = 0.54), and arrhythmia-free survival (P = 0.51). CONCLUSION: Patients with valvular cardiomyopathy and residual left ventricular dysfunction following valvular surgery who underwent a tailored approach to ICD implantation had similar overall and arrhythmia-free survival as patients with ischemic cardiomyopathy.