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Medline ® Abstract for Reference 23

of 'Wearable cardioverter-defibrillator'

23
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Equivalent arrhythmic risk in patients recently diagnosed with dilated cardiomyopathy compared with patients diagnosed for 9 months or more.
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Makati KJ, Fish AE, England HH, Tighiouart H, Estes NA 3rd, Link MS
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Heart Rhythm. 2006;3(4):397. Epub 2006 Feb 28.
 
BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) recently expanded coverage for implantable cardioverter-defibrillators (ICDs) in patients with left ventricular ejection fraction<or =35% and nonischemic dilated cardiomyopathy for>or =9 months. To investigate the ramifications of these criteria, the ICD registry from Tufts-New England Medical Center was analyzed for arrhythmic events and death in patients with newly diagnosed (<9 months) vs late-diagnosed (>or =9 months) nonischemic dilated cardiomyopathy.
OBJECTIVES: The purpose of this study was to analyze the arrhythmic risk in patients with recent vs late diagnosis of nonischemic dilated cardiomyopathy.
METHODS: One hundred thirty-one patients with nonischemic dilated cardiomyopathy were divided into two cohorts (<9 or>or =9 months of symptoms) and analyzed for any occurrence of treated ventricular arrhythmia, potentially lethal arrhythmias defined as ventricular flutter rates>or =230 bpm, and ventricular fibrillation. Patientswith documented sustained ventricular tachycardias (included in prior CMS coverage) were excluded.
RESULTS: In the study group, the mean age was 58.1 +/- 15 years and ejection fraction 20.6% +/- 8%. In a follow-up period of 25.3 +/- 24 months, the 52 patients with a recent diagnosis (1.4 +/- 2 months) had no difference in the occurrence of ventricular arrhythmias (P = .49) and malignant ventricular arrhythmias (P = .16) compared with the 79 patients diagnosed>or =9 months (mean 58.1 +/- 39 months).
CONCLUSION: Patients with nonischemic dilated cardiomyopathy experienced equivalent occurrences of treated and potentially lethal arrhythmias irrespective of diagnosis duration. These findings suggest that the 9-month time qualifier used in the CMS guidelines for ICD reimbursement may not reliably discriminate patients at high risk for sudden cardiac death in this selected population.
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Tufts University School of Medicine/New England Medical Center, Boston, Massachusetts 02111, USA. mlink@tufts-nemc.org
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