Renal insufficiency predicts the time to first appropriate defibrillator shock

Haitham Hreybe; Rana Ezzeddine; Maninder Bedi; William Barrington; Raveen Bazaz; Leonard I Ganz; Sandeep Jain; Ogundu Ngwu; Barry London; Samir Saba

doi:10.1016/j.ahj.2005.06.042

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Renal insufficiency predicts the time to first appropriate defibrillator shock

Journal article

Peer reviewed

Renal insufficiency predicts the time to first appropriate defibrillator shock

Haitham Hreybe, Rana Ezzeddine, Maninder Bedi, William Barrington, Raveen Bazaz, Leonard I Ganz, Sandeep Jain, Ogundu Ngwu, Barry London and Samir Saba

The American heart journal, Vol.151(4), pp.852-856

04/2006

DOI: 10.1016/j.ahj.2005.06.042

PMID: 16569548

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Abstract

Indications for implantable cardioverter defibrillator (ICD) implantation are expanding, but many primary and secondary ICD trials have excluded patients with advanced renal insufficiency. We investigated the effect of renal function on the incidence and time to first appropriate ICD shock. We analyzed data from all new ICD implantations at a tertiary care center from July 2001 to December 2002. During a mean follow-up time of 445 +/- 285 days, 29 (13%) of 230 patients (age 63 +/- 14 years, 79% men, 77% white, 75% coronary artery disease, left ventricular ejection fraction 0.28 +/- 0.14) received 41 appropriate shocks. Patients were divided into tertiles according to their serum creatinine level. The 1-year incidence of appropriate ICD shock was 3.8%, 10.8%, and 22.7% in the first, second, and third tertiles, respectively (P = .003). Using the same cut off values of serum creatinine, the 1-year incidence of appropriate ICD therapy (shock and antitachycardia pacing) was 8.8%, 20.8%, and 26.3% (P = .02). After correcting for age, sex, race, left ventricular ejection fraction, indication for ICD implantation, and use of beta-blockers in a Cox regression model, serum creatinine was still an independent predictor of the time to first appropriate ICD shock (hazard ratio 6.0 for the third compared with the first tertile, P = .001). Renal insufficiency is a strong predictor of appropriate ICD shocks. Defibrillator therapy should therefore not be withheld based on the presence of this comorbidity. The mechanisms underlying the relationship between renal function and ventricular arrhythmias deserve further investigation.

Arrhythmias, Cardiac - epidemiology

Multivariate Analysis

Comorbidity

Humans

Middle Aged

Risk Factors

Proportional Hazards Models

Coronary Disease - epidemiology

Male

Renal Insufficiency - epidemiology

Dyslipidemias - epidemiology

Defibrillators, Implantable

Creatinine - blood

Diabetic Angiopathies - epidemiology

Female

Aged

Retrospective Studies

Renal Dialysis

Details

Title: Subtitle: Renal insufficiency predicts the time to first appropriate defibrillator shock
Creators: Haitham Hreybe - University of Pittsburgh, Pittsburgh, PA 15213, USA
Rana Ezzeddine
Maninder Bedi
William Barrington
Raveen Bazaz
Leonard I Ganz
Sandeep Jain
Ogundu Ngwu
Barry London
Samir Saba
Resource Type: Journal article
Publication Details: The American heart journal, Vol.151(4), pp.852-856
Publisher: United States
DOI: 10.1016/j.ahj.2005.06.042
PMID: 16569548
ISSN: 0002-8703
eISSN: 1097-6744
Language: English
Date published: 04/2006
Academic Unit: Molecular Physiology and Biophysics; Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984025331402771

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