NCDR Study: Similar Mortality Rate Two Years After ICD Implantation in Patients With CS, Other Cardiomyopathies

Patients with cardiac sarcoidosis (CS) have similar a mortality rates two years following ICD implantation, compared with patients with non-ischemic cardiomyopathies (NICM), according to a study published Dec. 27 in American Heart Journal.

Angela Y. Higgins, MD, et al., used data from ACC's EP Device Implant Registry, previously the ICD Registry, to compare the risk of mortality among CS patients and other NICM patients. The researchers also looked at risk factors associated with an increased mortality risk after ICD implantation in CS patients. Patients were propensity matched, with one CS patient matching with up to five NICM patients, based on gender and age. The study's primary outcome was all-cause mortality two years after ICD implantation.

The study cohort comprised 452,595 patients, 2,162 and 450,433 with NICM, who received an ICD between 2010 and 2015. After 1:5 propensity score matching, there were 1,638 CS patients and 8,190 NICM patients. The average age of all patients was 57 years, and 40.6% of patients were female. Patients with CS were more likely than those with NICM to have ventricular tachycardia, syncope, inducible ventricular arrhythmia, abnormal intraventricular conduction, second-degree heart block and third-degree heart block.

Mortality rates were similar among patients with CS vs. NICM at one year (5.2% vs. 5.4%, p=0.75) and two years (9% vs. 9.3%, p=0.72). The overall two-year mortality rate of CS patients was similar to that of propensity-matched NICM patients (Adjusted Relative Risk: 1.03; 95% Confidence Interval [CI]: 0.87-1.23). CS patients with NYHA class III or class IV heart failure had a significantly higher mortality risk. In addition, mortality risk was higher among CS patients with atrial fibrillation/flutter, chronic lung disease, renal dysfunction and paced rhythm.

The researchers conclude that CS patients have a similar mortality two-year mortality rate as a propensity-matched cohort of NICM patients. They note that the factors associated with increased mortality risk among CS patients "may help inform clinicians and patients regarding mortality risk in those with CS considering ICD implantation and allow for improved prognostication and monitoring of CS patients with existing ICDs."

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure

Keywords: Atrial Fibrillation, Cardiomyopathies, Heart Failure, Tachycardia, Ventricular, Risk Factors, Registries, National Cardiovascular Data Registries, Kidney Diseases, Heart Block, Lung Diseases, Sarcoidosis, Syncope, EP Device Implant Registry

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