A10-2 Differences in ventricular arrhythmias developed by ischemic and non-ischemic heart failure patients implanted with biventricular cardioverter-defibrillators: The insync icd italian registry

Aim To evaluate the ventricular arhythmic events developed by ischemic (I) and non-ischemic (NI) heart failure (HF) patients (pts) implanted with an ICD for cardiac resyncronization therapy (CRT) {Medtronic InSync ICD} for primary (PP) or secondary prevention (SP) of sudden death. Methods 219 pts (91% male, age 65&10 yrs, NYHA 3.0&0.6, EF 26&7%, QRS 161&31 ms) were implanted and followed in the InSync ICD Italian Registry. Etiology was I in 58% and N-I in 42% of pts. 115 pts (53%) were implanted for SP (23 prior cardiac arrest, 66 recurrent sustained VT, 26 upgrade of ICD); 104 (47%) for PP. Results Over a median period of 13&7 months, pts with at least 6 months FU and compliant data were 130 (48 I, 62 NI). The efficacy of CRT was evident in term of functional improvement. 14 pts died for pump failure. 23 pts (11 I, 12 N-I) developed 88 ventricular arhythmic events (VAE): 75 VT, 13 VF. There were no statistical differences in term of baseline clinical condition, ICD indication (3 pts implanted for primary prevention in both groups) and VT/VF detection window programming between I and NI pts. 28 VAE (all VT: cycle length 337&50 ms) were recorded in I pts: 5 self-terminated, 11 terminated with ATP (9 with 1” ATP) and 12 with shock; 60 VAE (47 VT: cycle length 361&58 ms; 13 VF: cycle length 250&14 ms) in NI pts: 18 VT and 1 VF self-terminated, 17 VT terminated with ATP (16 with 1” ATP), 12 VT and 12 VF with shock. The main differences were: 1) more VAE in N-I group (60 vs 28; p=O.OOS); 2) higher percentage of VAE in NI group self-terminated (38% vs 17%; p=O.O6); 3) higher efficacy of 1” ATP in N-I group (84% vs 47%; p=O.O17); 4) less delivered therapies per patient in NI group (1.2&0.6 vs 1.6&0.7; p=O.O04) Conclusions: Our data indicate that in pts with HF, following CRT+ICD, the arhythmic profile may be different in I vs NI pts. In comparison with I pts, NI pts tend to have more arhythmic episodes but a substantial proportion of VT terminates spontaneously or is more easily terminated by ATP.