Abstract 942 Low incidence of sustained ventricular tachyarrhythmias in patients with non-ischemic cardiomyopathy in a large multicenter multinational WCD cohort

Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Low incidence of sustained ventricular tachyarrhythmias in patients with non-ischemic cardiomyopathy in a large multicenter multinational WCD cohort
J. W. Erath-Honold¹, K. Koepsel², B. Kovacs³, T. Dreher⁴, C. Blockhaus⁵, M. Gotzmann⁶, N. Klein⁷, D.-I. Shin⁵, M. Abumayyaleh⁴, H. Lapp⁸, A. Saguner³, F. Duru³, A. Mügge⁹, T. Beiert⁸, A. Aweimer², I. Akin⁴, I. El-Battrawy²
¹Med. Klinik III - Kardiologie, Angiologie, Universitätsklinikum Frankfurt, Frankfurt am Main; ²Medizinische Klinik II, Kardiologie und Angiologie, Berufsgenossenschaftlliches Universitätsklinikum Bergmannsheil, Bochum; ³Unispital Zürich, Zürich, CH; ⁴I. Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim; ⁵Medizinische Klinik I, HELIOS Klinikum Krefeld, Krefeld; ⁶Kardiologie und Rhytmologie, Kath. Klinikum Bochum, Bochum; ⁷Klinik für Kardiologie, Angiologie und intern. Intensivmedizin, Klinikum Sankt Georg, Leipzig; ⁸Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn; ⁹Medizinische Klinik II, Kardiologie, Klinikum der Ruhr-Universität Bochum, Bochum;
Background Defibrillator use in patients with non-ischemic cardiomyopathy (NICM) and HFrEF remains controversial after the DANISH study. The new ESC guidelines recommend individualized risk stratification in these patients. The wearable cardioverter-defibrillator (WCD) seems to be appropriate to both protect and screen patients with HFrEF at risk for SCD. Methods 1596 patients were included in a multicenter registry from eight European centers. Among these patients, 602 patients received a WCD due to ischemic cardiomyopathy (ICM) and 555 patients for non-ischemic cardiomyopathy (NICM). The mean follow-up time of the whole cohort was 620.2±607.8 days. Incidence of ventricular tachyarrhythmias and/or WCD shock discharge during WCD use were evaluated. Results NICM patients were younger (mean 56.5±14.8 years vs 63.9±11.6 years; p<0.001) and less often male (75% vs. 87.2%; p<0.001). Heart failure medication at hospital discharge did not differ between the two patient groups except for a higher prescription rate of aldosterone- antagonists in NICM patients compared to ICM patients (73.8% vs. 66.7; p=0.02). The index left ventricular ejection fraction (LVEF) was significantly lower in NICM patients compared to ICM patients (mean 26.1±9.1% versus 29.5±9.2%; p<0.001) but recovered more often until end of WCD use (mean 45.7±35.4% versus 40.2±11.8%; p=0.02). Average daily WCD use was significantly lower in NICM patients leading to a significantly lower compliance rate compared to ICM patients (mean 20.7±4.9 vs. 21.6±3.7; p<0.001; p=0.01). NICM patients had a significantly lower incidence of sustained ventricular tachycardia (VT) and ventricular fibrillation compared to ICM patients (sus VT: 1.1% vs. 3.8%; p=0.003; VF: 0.2% vs. 1.2%; p=0.07). Consequently, the rate of appropriate WCD shock was significantly lower in NICM vs ICM patients (0.7% vs. 3.7%; p< 0.001). During the WCD use a similar mortality rate was documented in both groups. Over long-term follow-up the rate of re-hospitalization was significantly lower in NICM vs. ICM patients (30.2% vs. 46.1%; p<0.001). Conclusions Patients at risk for sudden cardiac death with NICM had a significantly lower incidence of sustained ventricular tachyarrhythmias compared to patients with ICM while being temporarily protected with the WCD.
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