Alon Eisen1, Mahmoud Suleiman2, Boris Strasberg1, Ron Sela3, Shimon Rosenheck4, Nahum A Freedberg5, Michael Geist6, Shlomit Ben-Zvi7, Ilan Goldenberg7, Michael Glikson7, Moti Haim1. 1. Cardiology Department, Rabin Medical Center, Petah Tikva, Israel. 2. Cardiology Department, Rambam Medical Center, Bat Galim, Haifa, Israel. 3. Cardiology Department, Western Galilee Hospital, Nahariya, Israel. 4. Cardiology Department, Hadassah Ein Karem Hospital, Jerusalem, Israel. 5. Cardiology Department, Ha'Emek Medical Center, Afula, Israel. 6. Cardiology Department, Wolfson Medical Center, Holon, Israel. 7. Cardiology Department, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel.
Abstract
BACKGROUND: Implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) reduce mortality in patients with heart failure (HF) and left ventricular dysfunction. However, their efficacy in patients with chronic kidney disease (CKD) is controversial. OBJECTIVE: We examined the association between renal dysfunction and clinical outcomes in patients undergoing ICD and CRT defibrillator (CRTD) implantation. METHODS: Data were collected from the Israeli ICD registry. Estimated glomerular filtration rate (eGFR) at implantation was assessed using the modification of diet in renal disease formula. Primary outcome was all-cause mortality. Secondary outcomes included the composite endpoints of death or HF and death or ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]); any hospitalizations; first appropriate and inappropriate ICD therapy. RESULTS: During the study period (July 2010-November 2012), 2,811 patients were implanted with ICD or CRTD. One-year follow-up data were available for 730 ICD patients and 453 CRTD patients. Patients with eGFR < 30 mL/minute/1.73 m(2) (n = 54, 4.6%) were older, had a higher prevalence of diabetes, hypertension, or ischemic heart disease. eGFR <30 mL/minute/1.73 m(2) was associated with increased mortality risk in ICD (HR 5.4; 95% CI 1.5-19.2), but not in CRTD patients (HR 0.9; 95% CI 0.1-7.5). Renal dysfunction was associated with the composite endpoints of death or HF and death or VT/VF in ICD, but not in CRTD patients. Mean eGFR during follow-up decreased by 8.0 ± 4.3 mL/minute/1.73 m(2) in ICD patients (P = 0.06) and by 1.8 ± 1.3 mL/minute/1.73 m(2) in patients with CRTD (P = 0.2). CONCLUSION: Based on this retrospective analysis, CKD is associated with adverse prognosis after ICD implantation, but not after CRTD implantation. GFR decreased in patients with ICD, but not in CRTD patients.
BACKGROUND: Implantable cardioverter defibrillators (ICDs) and cardiac resynchronization therapy (CRT) reduce mortality in patients with heart failure (HF) and left ventricular dysfunction. However, their efficacy in patients with chronic kidney disease (CKD) is controversial. OBJECTIVE: We examined the association between renal dysfunction and clinical outcomes in patients undergoing ICD and CRT defibrillator (CRTD) implantation. METHODS: Data were collected from the Israeli ICD registry. Estimated glomerular filtration rate (eGFR) at implantation was assessed using the modification of diet in renal disease formula. Primary outcome was all-cause mortality. Secondary outcomes included the composite endpoints of death or HF and death or ventricular arrhythmias (ventricular tachycardia/ventricular fibrillation [VT/VF]); any hospitalizations; first appropriate and inappropriate ICD therapy. RESULTS: During the study period (July 2010-November 2012), 2,811 patients were implanted with ICD or CRTD. One-year follow-up data were available for 730 ICDpatients and 453 CRTD patients. Patients with eGFR < 30 mL/minute/1.73 m(2) (n = 54, 4.6%) were older, had a higher prevalence of diabetes, hypertension, or ischemic heart disease. eGFR <30 mL/minute/1.73 m(2) was associated with increased mortality risk in ICD (HR 5.4; 95% CI 1.5-19.2), but not in CRTD patients (HR 0.9; 95% CI 0.1-7.5). Renal dysfunction was associated with the composite endpoints of death or HF and death or VT/VF in ICD, but not in CRTD patients. Mean eGFR during follow-up decreased by 8.0 ± 4.3 mL/minute/1.73 m(2) in ICDpatients (P = 0.06) and by 1.8 ± 1.3 mL/minute/1.73 m(2) in patients with CRTD (P = 0.2). CONCLUSION: Based on this retrospective analysis, CKD is associated with adverse prognosis after ICD implantation, but not after CRTD implantation. GFR decreased in patients with ICD, but not in CRTD patients.
Authors: Mohammed Shurrab; Dennis T Ko; Yazan Zayed; Sankar D Navaneethan; Nour Yadak; Abeer Yaseen; Anna Kaoutskaia; Waad Qamhia; Zakaria Hamdan; Saleem Haj-Yahia; Douglas S Lee; David Newman; Jeff S Healey; Paula Harvey; Eugene Crystal Journal: J Interv Card Electrophysiol Date: 2018-07-30 Impact factor: 1.900
Authors: Giuseppe Boriani; Irina Savelieva; Gheorghe-Andrei Dan; Jean Claude Deharo; Charles Ferro; Carsten W Israel; Deirdre A Lane; Gaetano La Manna; Joseph Morton; Angel Moya Mitjans; Marc A Vos; Mintu P Turakhia; Gregory Y H Lip Journal: Europace Date: 2015-06-24 Impact factor: 5.214
Authors: G Bazoukis; K P Letsas; P Korantzopoulos; C Thomopoulos; K Vlachos; S Georgopoulos; N Karamichalakis; A Saplaouras; M Efremidis; A Sideris Journal: J Arrhythm Date: 2017-05-01