Prognostic role of left atrial enlargement in patients with implantable cardioverter defibrillators for primary prevention. Issue 1 (2nd January 2022)

• Record Type: Journal Article
• Authors: Bissolino, Arianna; Andreis, Alessandro; Magnano, Massimo; Budano, Carlo; Saglietto, Andrea; Angelini, Filippo; Roagna, Edoardo; Mattivi, Simone; Peyracchia, Mattia; Errigo, Daniele; Golzio, Pier Giorgio; Castagno, Davide; Giustetto, Carla; De Ferrari, Gaetano Maria
• Is Part Of: Acta cardiologica. Volume 77:Issue 1(2022)
• Page Start: 45
• Page End: 50
• Publication Date: 2022-01-02
• Subjects: ICD -- primary prevention -- left atrial volume index -- atrial dilatation -- shock -- inappropriate shock; Cardiology -- Periodicals; Cardiology; Cardiologie -- Périodiques; Cardiology; Cardiologie; Periodicals; Periodicals; 616.12005
• DOI: 10.1080/00015385.2020.1856491
• Languages: English
• ISSNs: 0001-5385

Abstract

Abstract: Purpose: Left atrial volume index (LAVI) is a predictor of heart failure and adverse events, irrespective of left ventricular systolic function. The role of LAVI in the prediction of appropriate implantable cardioverter-defibrillator (ICD) therapies is currently unclear and was the focus of this study. Methods: Consecutive heart failure patients with ischaemic (ICM) or idiopathic (DCM) aetiology receiving ICD for primary prevention were included. The primary endpoint was the occurrence of appropriate ICD therapies (ATs): shocks or antitachycardia pacing (ATP). Inappropriate ICD shocks were also assessed as secondary endpoint. Results: Among 198 included patients, severe left atrial dilatation (SLAE = LAVI ≥ 60 ml/m 2 ) was present in 54 (27%). SLAE patients had a higher prevalence of NYHA class ≥ III, severe mitral regurgitation and atrial fibrillation history. During a median follow-up of 45 months (IQR 25–68), ATs occurred more frequently in SLAE group (33% vs. 15%, p = .007) as well as appropriate shocks (24% vs. 10%, p = .014). At multivariate analysis SLAE was an independent predictor of ATs (OR 3.19, 95% CI 1.38–7.38, p = .007). Inappropriate shocks were associated with AF during implantation ( p = .03), but not with SLAE ( p = .009). Conclusion: In DCM or ICM patients candidate to receive an ICD for primary prevention, a severely enlarged left atrium is a predictive factor for ATs (shocks or ATP). The risk of inappropriate shocks was increased in patients with atrial fibrillation, rather than SLAE.