Posted on 01/05/2012

Chronic total coronary occlusions (CTO) independently predicted the occurrence of ventricular arrhythmias in ischemic heart disease patients with implantable cardioverter defibrillators (ICDs), according to a single-center study. The presence of at least one CTO was associated with a higher rate of appropriate ICD therapy for ventricular arrhythmias during each of three years of follow-up, reported Luis Nombela-Franco, MD, from the Hospital Universitario Puerto de Hierro-Majadahonda in Madrid, Spain, and colleagues. CTO also were independent predictors of mortality in each of three years of follow-up, according to the study published online in Circulation: Arrhythmia and Electrophysiology. The investigators noted that ventricular arrhythmias are the cause of most cases of sudden cardiac death.

The increasing number of ICDs being implanted for primary prevention has many concerned because up to three-quarters of these patients will never receive an ICD shock. One-third of patients with significant coronary disease have chronic total coronary occlusions, which are associated with long-term mortality in patients with previous myocardial infarction. This study shows that chronic coronary total occlusion is an independent predictor for the occurrence of ventricular arrhythmias and higher-long term mortality in patients with ischemic heart disease receiving ICDs for primary prevention of sudden death and is associated with appropriate ICD intervention. Therefore, physicians would like to have a better way to differentiate between those who truly need the device and those who do not.

SOURCE: MedPage Today More...

Primary source: Circulation: Arrhythmia and Electrophysiology Source reference: Nombela-Franco L, et al "Ventricular arrhythmias among implantable cardioverter defibrillator recipients for primary prevention: Impact of chronic total coronary occlusion (VACTO primary study)" 

Circ Arrhythm Electrophysiol 2011; DOI: 10.1161/CIRCEP.111.968008.

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