{"title":"A Practical Scoring System for Estimating Ventricular Arrhythmia Events in Patients with Cardiac Resynchronization Therapy for Primary Prevention.","authors":"Takayuki Goto, Yasuya Inden, Satoshi Yanagisawa, Naoki Tsurumi, Kiichi Miyamae, Hiroyuki Miyazawa, Shun Kondo, Masaya Tachi, Tomoya Iwawaki, Ryota Yamauchi, Kei Hiramatsu, Masafumi Shimojo, Yukiomi Tsuji, Toyoaki Murohara","doi":"10.1536/ihj.24-646","DOIUrl":null,"url":null,"abstract":"<p><p>The prognostic value of defibrillators in cardiac resynchronization therapy (CRT) for primary prevention remains debatable. Predicting ventricular arrhythmias (VAs) before implantation is useful for deciding whether to add a defibrillator to a CRT device. This study aimed to determine the risk factors for VA events after CRT device implantation and to construct a scoring model. A total of 153 patients who underwent CRT device implantation, with no history of sustained ventricular tachycardia or ventricular fibrillation (including 25 patients with CRT pacemakers) and with follow-up period >1 year after implantation were included. We assessed VA events requiring implantable cardioverter-defibrillator therapy and sustained VA events requiring clinical treatment. During a mean follow-up of 6.3 years, 24 patients (16%) received therapy for VA. Multivariate analysis revealed age ≤ 70 years (hazard ratio [HR] 2.936, P = 0.037), administration of tolvaptan (HR 11.259, P < 0.001), and coronary artery disease (HR 2.444, P = 0.045) were independent predictors for VA events. Risk scores were assigned based on the HR for each predictor, and the population was divided into 3 risk groups (low: 0 points; moderate: 1-3 points; high: 4-5 points). VAs occurred less frequently in the low-risk group than in the other risk groups (low: 8.1%; moderate: 18%; high: 21%) (log-rank, P < 0.001). No significant differences in mortality were observed between the groups, whereas hospitalization for heart failure occurred more frequently in the high-risk group than in the other groups. In conclusion, a scoring system using specific background information may help predict VA events in prophylactic CRT recipients.</p>","PeriodicalId":13711,"journal":{"name":"International heart journal","volume":" ","pages":"241-251"},"PeriodicalIF":1.2000,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International heart journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1536/ihj.24-646","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/15 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
The prognostic value of defibrillators in cardiac resynchronization therapy (CRT) for primary prevention remains debatable. Predicting ventricular arrhythmias (VAs) before implantation is useful for deciding whether to add a defibrillator to a CRT device. This study aimed to determine the risk factors for VA events after CRT device implantation and to construct a scoring model. A total of 153 patients who underwent CRT device implantation, with no history of sustained ventricular tachycardia or ventricular fibrillation (including 25 patients with CRT pacemakers) and with follow-up period >1 year after implantation were included. We assessed VA events requiring implantable cardioverter-defibrillator therapy and sustained VA events requiring clinical treatment. During a mean follow-up of 6.3 years, 24 patients (16%) received therapy for VA. Multivariate analysis revealed age ≤ 70 years (hazard ratio [HR] 2.936, P = 0.037), administration of tolvaptan (HR 11.259, P < 0.001), and coronary artery disease (HR 2.444, P = 0.045) were independent predictors for VA events. Risk scores were assigned based on the HR for each predictor, and the population was divided into 3 risk groups (low: 0 points; moderate: 1-3 points; high: 4-5 points). VAs occurred less frequently in the low-risk group than in the other risk groups (low: 8.1%; moderate: 18%; high: 21%) (log-rank, P < 0.001). No significant differences in mortality were observed between the groups, whereas hospitalization for heart failure occurred more frequently in the high-risk group than in the other groups. In conclusion, a scoring system using specific background information may help predict VA events in prophylactic CRT recipients.
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