262 Implantable Cardioverter Defibrillator

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Implantable Cardioverter Defibrillator late gadolinium enhancement imaging. LGE was defined "complex" (Cx-LGE) in presence of one of the following: 1) ...
262

Implantable Cardioverter Defibrillator

late gadolinium enhancement imaging. LGE was defined "complex" (Cx-LGE) in presence of one of the following: 1) ischemic pattern, involving ≥ 2 different coronary territories; 2) epicardial distribution; 3) "diffuse" subendocardial; 4) presence of ≥ 2 different patterns. Patients were regularly followed and appropriate ICD interventions were detected. The primary end-point was the occurrence of a sustained ventricular arrhythmia requiring an ICD therapy. A composite secondary end-point of cardiovascular death, cardiac transplantation or ventricular assist device implantation was also considered. Results: During a median follow-up of 30 months, 21 (22%) and 17 (18%) patients reached the primary and secondary end-point, respectively. Only one patient experienced an ICD shock before heart transplantation. At univariate analysis, Cx-LGE was highly predictive of primary end-point occurrence (HR=3.79 [C.I. 95%:1.53-9.40], p=0.004), as well as implant indication for secondary prevention (HR=2.79 [C.I.95%:1.08-7.23], p=0.034) and NYHA class (HR=0.34 [C.I.95%:0.18-0.64], p 2, presence of diabetes, renal failure, sinus rhythm, CRT-, therapy with betablocker, ACEs, diuretics and age > 70 years. Results: 116 pts were included, age 59±10 yrs, LVEF 26±7%. 90% male, 66% ischemic cardiomyopathy, 41% CRT-D, 49% NYHA class > 2 and 22% renal failure. Follow-up after replacement was 28±8 months. 18 (15%) patients had ICD-T after replacement. The figure shows the distribution of patients with ICD-T before and after replacement. Cumulative incidence of ICD-T at 3 yrs was 46% and 10%, respectively. Of the 7 pts who had the first ICD-T after replacement, the arrhythmia was VF in 1, fast VT in 2 and VT in 4 pts. Univariate analysis revealed no single predictive factor.

Conclusion: As in pts with secondary prevention indication, a significant number of primary prevention patients without ICD-T before device replacement receive a first ICD-T during further follow-up (cumulative incidence at 3 yrs 10%), even though the rate is lower. No risk factors could be identified.

P1391 | BEDSIDE Costs of remote monitoring versus ambulatory follow-up of implanted cardioverter defibrillators in the randomized ECOST study S. Kacet 1 , L.G. Guedon-Moreau 1 , D.L. Lacroix 1 , N.S. Sadoul 2 , J.C. Clementy 3 , C.K. Kouakam 1 , J.S.H. Hermida 4 , E.A. Aliot 2 on behalf of ECOST. 1 Hospital Regional University of Lille - Cardiological Hospital, Lille, France; 2 University Hospital of Nancy - Hospital Brabois, Vandoeuvre les Nancy, France; 3 CHU de Bordeaux - Service de Cardiologie, Pessac, France; 4 Amiens University Hospital, Department of Cardiology, Amiens, France Background: The randomized ECOST study demonstrated the safety and effec-