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Valentino, Mariana*; Mont, Lluis;
Cuesta, Alejandro; Matas, Mariona;
Arrhythmias Section. CV Institute. Clinic
Hospital. Barcelona. Spain.
*Arrhythmias Unit. Sanatorio Delta. Rosario. Argentina
Patients with non-ischemic dilated cardiomyopathy (DCM)
often die suddenly due to malignant ventricular arrhythmias. The objective of
the study was to analyze clinical characteristics and outcome of patients with
DCM who received an implantable defibrillator (ICD) in terms of arrhythmia recurrence,
compared with a control group of patients with a healed
myocardial infarction (MI). The study group comprised 33 patients with DCM and 88 patients with MI. All ICD´s allowed electrogram storage.
Results: There were no significant differences among the clinical characteristics; age (63±9 vs. 63±10 years), sex (male, 95% vs. 97%) and prescription of antiarrhythmic drugs (60% vs. 55%). DCM patients had a lower ejection fraction, (28±9 vs. 33±10, p=0.03) and a higher functional class (III/IV 36% vs. 10%, p<0.01). Cardiac arrest or syncope as presenting symptoms was more often observed in DCM patients (p=0.05). Indications for implantation were equally distributed among the two groups: Sustained monomorphic ventricular tachycardia (SMVT) (65% vs. 46%), cardiac arrest (18% vs. 24%), syncope an inducible arrhythmias (17% vs. 30%). Inducibility of ventricular arrhythmias in the EPS study was more frequent in MI (99% vs. 76%, p<0.0001), but there was no difference in the number of extrastimuli needed to induce the arrhythmia or in the SMVT tolerability. Rapid pacing terminated the tachycardia more often in MI patients (54% vs. 36% p=0.04). Follow-up period was 21±12 vs. 25±23 months for MI and DCM respectively (p=NS). Mortality was 6% in both groups. There were no differences between the two groups in terms of arrhythmia recurrence (52% vs. 58%), number of episodes/patient (1.3±2.8 vs. 2.8±5.5) and the rate of VT episodes (188±29 vs.198±31 bpm). Effectiveness of antitachycardia pacing in DCM was 86%.
Conclusions: Despite baseline
differences between DCM and MI in terms of ejection fraction functional class
and EPS the probability and the number of arrhythmia recurrences are similar
in both populations. ATP was also highly
effective in DCM patients.
2nd Virtual Congress of Cardiology
Dr. Florencio Garófalo
Dr. Raúl Bretal
Dr. Armando Pacher
Technical Committee - CETIFAC
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