M. Kuhne

Incidence of and predictors for appropriate implantable cardioverter-defibrillator therapy in patients with a secondary preventive implantable cardioverter-defibrillator indication

AIMSnIncidence of implantable cardioverter-defibrillator (ICD) therapy in secondary prevention has been assessed in randomized trials and registries. However, results are considerably limited by short follow-up and hazy definition of treated arrhythmias. This study aimed to determine appropriate ICD therapy and to define predictors based on registry patients followed for up to 20 years.nnnMETHODS AND RESULTSnAll patients with a secondary prevention indication and ischaemic or dilated cardiomyopathy were identified. Arrhythmic endpoints were appropriate ICD therapies for any ventricular tachycardia (VT) >175 b.p.m. and appropriate ICD therapies in the ventricular fibrillation (VF) zone of >220 b.p.m. (potentially life-threatening). Predictors were determined by analysing 19 baseline characteristics. We included 357 patients, age 65 ± 11 years, predominantly male (89%) with ischaemic cardiomyopathy (83%). During follow-up of 82 ± 53 months, 156 (44%) patients died and 208 received any form of ICD therapies (59%), 71 of them (34%) in the VF zone. Forty-four patients (28%) died without experiencing any form of appropriate ICD therapy. Cumulative incidence of any form of ICD therapy at 10 years was 65%. Predictors for any form of ICD therapy were implantation for VT and age [VT: hazard ratio (HR) 1.45, 95% confidence interval (95% CI) 1.05-2.01, P = 0.03; age (per year): HR 1.02, 95% CI 1.01-1.04, P = 0.001]. For therapy in the VF zone, univariate analysis determined male gender (29 vs. 5%, P = 0.01) as predictor.nnnCONCLUSIONnThe rate of appropriate ICD therapies in secondary prevention is high. No useful predictors for them, especially not for life-threatening arrhythmias could be identified.

X-ray-free implantation of a permanent pacemaker during pregnancy using a 3D electro-anatomic mapping system

A 30-year-old patient presented with new-onset dizziness and palpitations in her 9th week of gestation. Physical examination revealed cannon waves upon inspection of her jugular veins. Electrolytes were within normal range. A 12-lead electrocardiogram (ECG) showed sinus rhythm at a rate of 94 bpm and complete atrio-ventricular (AV) block with a …

Very Late Follow‐Up of a Passive Defibrillator Lead Under Recall: Do Failure Rates Increase during Long‐Term Observation

The Medtronic Sprint Fidelis lead (SFL; Medtronic Inc., Minneapolis, MN, USA) has a significantly impaired long‐term survival, and active fixation leads fare worse than passive leads. The goal of this study was to present data of a series of passive SFL only with very long mean follow‐up of more than 6 years.