Meta-analysis of Risk of Ventricular Arrhythmias After Improvement in Left Ventricular Ejection Fraction During Follow-Up in Patients With Primary Prevention Implantable Cardioverter Defibrillators

Aiman Smer, Alok Saurav, Muhammad Soubhi Azzouz, Mohsin Salih, Mohamed Ayan, Ahmed Abuzaid, Abhilash Akinapelli, Arun Kanmanthareddy, Lynda E. Rosenfeld, Faisal M. Merchant, Hussam Abuissa

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Abstract

Implantable cardioverter defibrillators (ICDs) reduce the risk of sudden cardiac death in patients with impaired left ventricular ejection fraction (LVEF). However, there are limited data on the long-term benefit of ICD therapy in patients whose LVEF subsequently improves. We conducted a meta-analysis to evaluate the effect of LVEF improvement on ICD therapy during follow-up. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated using random-effects modeling. Sixteen studies with 3,959 patients were included in our analysis. Study arms were defined by LVEF improvement at follow-up (improved LVEF [>35%]: 1,622; low LVEF [≤35%] 2,337). Mean age (64.8 vs 64.9 years, p = 0.97) was similar, whereas men were overrepresented in the persistent low LVEF group (79% vs 72%, p <0.001). Appropriate ICD therapy rate was 9.7% (improved LVEF) versus 21.8% (low LVEF) over a median follow-up period of 2.9 years. In the meta-analysis, improved LVEF group had significantly lower (3.3% vs 7.2% per year IRR 0.52; CI 0.38 to 0.70; p <0.001) appropriate ICD therapies which was uniformly seen across all subgroups (ICD-only studies: IRR 0.59; p = 0.004) (cardiac resynchronization therapy-defibrillator–only studies: IRR 0.31; p = 0.002) (super-responder studies [mean LVEF > 45%]: IRR 0.53; p = 0.002). Inappropriate ICD therapy rates were, however, similar in both groups (3.01% vs 2.56% per year IRR 0.76; CI 0.43 to 1.36; p = 0.35). All-cause mortality rates in our meta-analysis favored (3.63% vs 8.23% per year IRR 0.49; CI 0.35 to 0.69; p <0.001) the improved LVEF group. In conclusion, our meta-analysis demonstrates that an improvement in LVEF is associated with a significantly reduced risk of ventricular arrhythmia and mortality. However, inappropriate ICD therapy rates remain similar.

Original languageEnglish (US)
Pages (from-to)279-286
Number of pages8
JournalAmerican Journal of Cardiology
Volume120
Issue number2
DOIs
StatePublished - Jul 15 2017

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Implantable Defibrillators
Primary Prevention
Stroke Volume
Meta-Analysis
Cardiac Arrhythmias
Incidence
Confidence Intervals
Mortality
Sudden Cardiac Death
Therapeutics

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Meta-analysis of Risk of Ventricular Arrhythmias After Improvement in Left Ventricular Ejection Fraction During Follow-Up in Patients With Primary Prevention Implantable Cardioverter Defibrillators. / Smer, Aiman; Saurav, Alok; Azzouz, Muhammad Soubhi; Salih, Mohsin; Ayan, Mohamed; Abuzaid, Ahmed; Akinapelli, Abhilash; Kanmanthareddy, Arun; Rosenfeld, Lynda E.; Merchant, Faisal M.; Abuissa, Hussam.

In: American Journal of Cardiology, Vol. 120, No. 2, 15.07.2017, p. 279-286.

Research output: Contribution to journalArticle

Smer, Aiman ; Saurav, Alok ; Azzouz, Muhammad Soubhi ; Salih, Mohsin ; Ayan, Mohamed ; Abuzaid, Ahmed ; Akinapelli, Abhilash ; Kanmanthareddy, Arun ; Rosenfeld, Lynda E. ; Merchant, Faisal M. ; Abuissa, Hussam. / Meta-analysis of Risk of Ventricular Arrhythmias After Improvement in Left Ventricular Ejection Fraction During Follow-Up in Patients With Primary Prevention Implantable Cardioverter Defibrillators. In: American Journal of Cardiology. 2017 ; Vol. 120, No. 2. pp. 279-286.
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abstract = "Implantable cardioverter defibrillators (ICDs) reduce the risk of sudden cardiac death in patients with impaired left ventricular ejection fraction (LVEF). However, there are limited data on the long-term benefit of ICD therapy in patients whose LVEF subsequently improves. We conducted a meta-analysis to evaluate the effect of LVEF improvement on ICD therapy during follow-up. Incidence rate ratios (IRRs) with 95{\%} confidence intervals (CIs) were calculated using random-effects modeling. Sixteen studies with 3,959 patients were included in our analysis. Study arms were defined by LVEF improvement at follow-up (improved LVEF [>35{\%}]: 1,622; low LVEF [≤35{\%}] 2,337). Mean age (64.8 vs 64.9 years, p = 0.97) was similar, whereas men were overrepresented in the persistent low LVEF group (79{\%} vs 72{\%}, p <0.001). Appropriate ICD therapy rate was 9.7{\%} (improved LVEF) versus 21.8{\%} (low LVEF) over a median follow-up period of 2.9 years. In the meta-analysis, improved LVEF group had significantly lower (3.3{\%} vs 7.2{\%} per year IRR 0.52; CI 0.38 to 0.70; p <0.001) appropriate ICD therapies which was uniformly seen across all subgroups (ICD-only studies: IRR 0.59; p = 0.004) (cardiac resynchronization therapy-defibrillator–only studies: IRR 0.31; p = 0.002) (super-responder studies [mean LVEF > 45{\%}]: IRR 0.53; p = 0.002). Inappropriate ICD therapy rates were, however, similar in both groups (3.01{\%} vs 2.56{\%} per year IRR 0.76; CI 0.43 to 1.36; p = 0.35). All-cause mortality rates in our meta-analysis favored (3.63{\%} vs 8.23{\%} per year IRR 0.49; CI 0.35 to 0.69; p <0.001) the improved LVEF group. In conclusion, our meta-analysis demonstrates that an improvement in LVEF is associated with a significantly reduced risk of ventricular arrhythmia and mortality. However, inappropriate ICD therapy rates remain similar.",
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AU - Smer, Aiman

AU - Saurav, Alok

AU - Azzouz, Muhammad Soubhi

AU - Salih, Mohsin

AU - Ayan, Mohamed

AU - Abuzaid, Ahmed

AU - Akinapelli, Abhilash

AU - Kanmanthareddy, Arun

AU - Rosenfeld, Lynda E.

AU - Merchant, Faisal M.

AU - Abuissa, Hussam

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N2 - Implantable cardioverter defibrillators (ICDs) reduce the risk of sudden cardiac death in patients with impaired left ventricular ejection fraction (LVEF). However, there are limited data on the long-term benefit of ICD therapy in patients whose LVEF subsequently improves. We conducted a meta-analysis to evaluate the effect of LVEF improvement on ICD therapy during follow-up. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated using random-effects modeling. Sixteen studies with 3,959 patients were included in our analysis. Study arms were defined by LVEF improvement at follow-up (improved LVEF [>35%]: 1,622; low LVEF [≤35%] 2,337). Mean age (64.8 vs 64.9 years, p = 0.97) was similar, whereas men were overrepresented in the persistent low LVEF group (79% vs 72%, p <0.001). Appropriate ICD therapy rate was 9.7% (improved LVEF) versus 21.8% (low LVEF) over a median follow-up period of 2.9 years. In the meta-analysis, improved LVEF group had significantly lower (3.3% vs 7.2% per year IRR 0.52; CI 0.38 to 0.70; p <0.001) appropriate ICD therapies which was uniformly seen across all subgroups (ICD-only studies: IRR 0.59; p = 0.004) (cardiac resynchronization therapy-defibrillator–only studies: IRR 0.31; p = 0.002) (super-responder studies [mean LVEF > 45%]: IRR 0.53; p = 0.002). Inappropriate ICD therapy rates were, however, similar in both groups (3.01% vs 2.56% per year IRR 0.76; CI 0.43 to 1.36; p = 0.35). All-cause mortality rates in our meta-analysis favored (3.63% vs 8.23% per year IRR 0.49; CI 0.35 to 0.69; p <0.001) the improved LVEF group. In conclusion, our meta-analysis demonstrates that an improvement in LVEF is associated with a significantly reduced risk of ventricular arrhythmia and mortality. However, inappropriate ICD therapy rates remain similar.

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