Combined plasma levels of A-type-natriuretic peptide and adrenomedullin are associated with appropriate anti-arrhythmia therapy in patients with an implantable cardioverter defibrillator but no prior device therapy.

Abstract

Background: Identifying patients benefiting from implantable cardioverter defibrillators (ICD) especially when replacing one that has never served may be challenging.

Objectives: We assessed the association between plasma levels of mid-regional-pro-A-type-natriuretic peptide (ANP), Mid-regional-pro-adrenomedullin (ADM) and aldosterone and, appropriate Implantable Cardioverter Defibrillator (ICD)-therapy in patients with an ICD but no prior therapy.

Methods: A cohort of 331 consecutive patients with an ICD but no prior ICD-therapy was prospectively included in 2 centers and followed-up for a median of 7.9 years. Plasma aldosterone, ANP and ADM levels were measured at inclusion. The primary outcome was the occurrence of appropriate ICD-therapy.

Results: Appropriate ICD-therapy and death occurred in 106(32%) and 114(34%) patients respectively. Rates of ICD generator replacement were 62% regardless of ICD-therapy. The multivariable model showed significant relationships between ANP > median (adjusted HR 1.73[95% CI 1.04-2.86]) and ADM > median (HR 0.53 [95% CI 0.32-0.89]) but not aldosterone, and ICD-therapy. The Fine and Gray analysis accounting mortality as a competing risk showed similar results.

Conclusions: The combination of ANP and ADM are independently associated with the risk of ICD-therapy in patients with an ICD that has never served, and may participate in stratifying patients who may benefit most from ICD generator replacement.