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- AVID, Antiarrhythmics Versus Implantable Defibrillators
- CHF, congestive heart failure
- ICD, implantable cardioverter defibrillator
- LVEF, left ventricular ejection fraction
- MUSTT, Multicenter Unsustained Tachycardia Trial
- NT-proBNP, N-terminal pro-brain natriuretic peptide
- NYHA, New York Heart Association
- RR, relative risk
- SCD, sudden cardiac death
- VT, ventricular tachycardia
Identification of patients with congestive heart failure (CHF) at risk for sudden cardiac death (SCD) remains a major problem. Implantable cardioverter-defibrillator (ICD) implantation constitutes an effective preventive strategy, both for primary and for secondary prevention of SCD.1,2 Evidence regarding the benefit of ICD implantation in patients with advanced CHF is limited, however, as death caused by pump failure becomes more important in these patients and the projected life span is short. Improved risk stratification for identification of appropriate candidates for ICD implantation appears critical to ensure access of eligible patients to this lifesaving treatment and to spare inappropriate candidates the side effects. Cost effectiveness is critically dependent on identification of appropriate high-risk subgroups in patient groups with low left ventricular ejection fraction (LVEF).1 The role of the B-type natriuretic peptides in predicting mortality in patients with CHF including SCD is increasingly being recognised.3,4 The definition of SCD used in clinical trials does not rule out ischaemic or non-cardiac causes of death, however, as shown by an autopsy study.5 The present study evaluated the hypothesis that raised N-terminal pro-brain natriuretic peptide (NT-proBNP) concentrations may predict ventricular tachyarrhythmia as a surrogate marker of SCD in patients with ischaemic CHF and an ICD device.
NT-proBNP concentrations (Roche Diagnostics, Mannheim, Germany) were determined at ICD implantation in patients with ischaemic CHF (scintigraphic LVEF ⩽ 30%) and were correlated with the results of ICD interrogation during the first postoperative year. Exclusion criteria were NT-proBNP measurement unavailable …
Funding: This work has not been funded by specific grants or financial support from other sources and there is no conflict of interest with any of the authors.
Competing interests: The contributing authors have not been influenced in any way by a conflict of interest by sponsoring or the like from a pharmaceutical company or any other external influence in the design, data collection, processing of data and writing of this manuscript.
Ethical approval: Patient data and all patient-related information were gathered and processed after patient consent was obtained. All data were processed with utmost care to preserve privacy and all steps were in accordance with the requirements of the local ethics committee in Heidelberg.
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