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Medline ® Abstract for Reference 23

of 'Wearable cardioverter-defibrillator'

Equivalent arrhythmic risk in patients recently diagnosed with dilated cardiomyopathy compared with patients diagnosed for 9 months or more.
Makati KJ, Fish AE, England HH, Tighiouart H, Estes NA 3rd, Link MS
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.
Tufts University School of Medicine/New England Medical Center, Boston, Massachusetts 02111, USA. mlink@tufts-nemc.org