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Heart failure and the risk of shocks in patients with implantable cardioverter defibrillators: results from the Triggers Of Ventricular Arrhythmias (TOVA) study.
Circulation. 2004 Mar 23; 109(11):1386-91.Circ

Abstract

BACKGROUND

Left ventricular ejection fraction (LVEF) predicts device discharges in patients with implantable cardioverter-defibrillators (ICDs). The relationship between severity of congestive heart failure (CHF) and ICD discharges is less clear.

METHODS AND RESULTS

We prospectively analyzed the association between CHF and risk of appropriate ICD discharges in the Triggers Of Ventricular Arrhythmias (TOVA) study, a cohort study of ICD patients conducted at 31 centers in the United States. Reported shocks were confirmed for sustained ventricular tachycardia (VT) or fibrillation (VF) by analysis of stored electrograms. Proportional hazards models included CHF categorized by New York Heart Association class. Baseline CHF was present among 502 (44%) of 1140 patients; 170 (34%) had class I, 230 (46%) had class II, 97 (19%) had class III, and only 5 (1%) had class IV symptoms. During median follow-up of 212 days, 92 patients experienced 1 or more appropriate ICD discharges. Class III CHF was associated in a statistically significantly manner with ICD discharge for VT/VF (hazard ratio 2.40, 95% CI 1.16 to 4.98), even with adjustment for LVEF. The combination of LVEF <0.20 and class III symptoms resulted in a particularly high risk of shocks for VT/VF (hazard ratio 3.90, 95% CI 1.28 to 11.92).

CONCLUSIONS

Class III CHF, an easily accessible clinical measure, is an independent risk factor, along with LVEF, for ventricular arrhythmias that require shock therapy among ICD patients. Whether patients with class III CHF benefit to a greater degree from ICDs and whether aggressive treatment of CHF in ICD patients may prevent ventricular arrhythmias remains to be determined.

Authors+Show Affiliations

Cardiovascular Division, Bulfinch 001, Massachusetts General Hospital, 55 Fruit St, Boston, Mass 02114, USA. wwhang@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

14993132

Citation

Whang, William, et al. "Heart Failure and the Risk of Shocks in Patients With Implantable Cardioverter Defibrillators: Results From the Triggers of Ventricular Arrhythmias (TOVA) Study." Circulation, vol. 109, no. 11, 2004, pp. 1386-91.
Whang W, Mittleman MA, Rich DQ, et al. Heart failure and the risk of shocks in patients with implantable cardioverter defibrillators: results from the Triggers Of Ventricular Arrhythmias (TOVA) study. Circulation. 2004;109(11):1386-91.
Whang, W., Mittleman, M. A., Rich, D. Q., Wang, P. J., Ruskin, J. N., Tofler, G. H., Muller, J. E., & Albert, C. M. (2004). Heart failure and the risk of shocks in patients with implantable cardioverter defibrillators: results from the Triggers Of Ventricular Arrhythmias (TOVA) study. Circulation, 109(11), 1386-91.
Whang W, et al. Heart Failure and the Risk of Shocks in Patients With Implantable Cardioverter Defibrillators: Results From the Triggers of Ventricular Arrhythmias (TOVA) Study. Circulation. 2004 Mar 23;109(11):1386-91. PubMed PMID: 14993132.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Heart failure and the risk of shocks in patients with implantable cardioverter defibrillators: results from the Triggers Of Ventricular Arrhythmias (TOVA) study. AU - Whang,William, AU - Mittleman,Murray A, AU - Rich,David Q, AU - Wang,Paul J, AU - Ruskin,Jeremy N, AU - Tofler,Geoffrey H, AU - Muller,James E, AU - Albert,Christine M, AU - ,, Y1 - 2004/03/01/ PY - 2004/3/3/pubmed PY - 2004/7/9/medline PY - 2004/3/3/entrez SP - 1386 EP - 91 JF - Circulation JO - Circulation VL - 109 IS - 11 N2 - BACKGROUND: Left ventricular ejection fraction (LVEF) predicts device discharges in patients with implantable cardioverter-defibrillators (ICDs). The relationship between severity of congestive heart failure (CHF) and ICD discharges is less clear. METHODS AND RESULTS: We prospectively analyzed the association between CHF and risk of appropriate ICD discharges in the Triggers Of Ventricular Arrhythmias (TOVA) study, a cohort study of ICD patients conducted at 31 centers in the United States. Reported shocks were confirmed for sustained ventricular tachycardia (VT) or fibrillation (VF) by analysis of stored electrograms. Proportional hazards models included CHF categorized by New York Heart Association class. Baseline CHF was present among 502 (44%) of 1140 patients; 170 (34%) had class I, 230 (46%) had class II, 97 (19%) had class III, and only 5 (1%) had class IV symptoms. During median follow-up of 212 days, 92 patients experienced 1 or more appropriate ICD discharges. Class III CHF was associated in a statistically significantly manner with ICD discharge for VT/VF (hazard ratio 2.40, 95% CI 1.16 to 4.98), even with adjustment for LVEF. The combination of LVEF <0.20 and class III symptoms resulted in a particularly high risk of shocks for VT/VF (hazard ratio 3.90, 95% CI 1.28 to 11.92). CONCLUSIONS: Class III CHF, an easily accessible clinical measure, is an independent risk factor, along with LVEF, for ventricular arrhythmias that require shock therapy among ICD patients. Whether patients with class III CHF benefit to a greater degree from ICDs and whether aggressive treatment of CHF in ICD patients may prevent ventricular arrhythmias remains to be determined. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/14993132/Heart_failure_and_the_risk_of_shocks_in_patients_with_implantable_cardioverter_defibrillators:_results_from_the_Triggers_Of_Ventricular_Arrhythmias__TOVA__study_ L2 - https://www.ahajournals.org/doi/10.1161/01.CIR.0000120703.99433.1E?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -