Outcomes in Patients With Mitral Annular Disjunction and an Implantable-Cardioverter Defibrillator

IF 2.6 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiovascular Electrophysiology Pub Date : 2025-03-17 DOI:10.1111/jce.16612

Fatima M. Ezzeddine, Jee Won Jennifer Shin, Konstantinos C. Siontis, Ammar M. Killu, John Giudicessi, Michael J. Ackerman, Abhishek J. Deshmukh, Gurukripa N. Kowlgi, Malini Madhavan, Christopher J. McLeod, Samuel J. Asirvatham, Freddy Del-Carpio Munoz

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Abstract

Background

Mitral annular disjunction (MAD) carries an increased risk of complex ventricular arrhythmias, which can lead to sudden cardiac death. Many of these patients undergo implantable cardioverter defibrillator (ICD) implantation, but their ICD outcomes are not known.

Objective

The aim of this study was to assess the outcomes of ICD implantation and the predictors of appropriate ICD therapies in patients with MAD.

Methods

The study included patients with MAD who underwent ICD implantation. Clinical, electrocardiographic, cardiac imaging, and device therapy data were collected.

Results

Forty-nine patients with MAD and ICD were included. Median age was 49 (21) years, and 29 (59%) were female. 13 (27%) patients underwent ICD implantation for primary prevention and 36 (73%) patients for secondary prevention. Over a median follow-up of 27.3 (35.3) months, 23 (47%) patients received ICD therapies. 18 (37%) patients had appropriate ICD therapies, and 5 (10%) patients had inappropriate ICD shocks. Median time to first appropriate therapy was 22.3 (63.3) months. In patients with a secondary prevention ICD indication, the rate of appropriate ICD therapies was 44%, while in patients with a primary prevention ICD indication, it was 15%. Among patients with appropriate ICD therapies, the first therapies were delivered for monomorphic ventricular tachycardia (VT) in 7 (39%) patients and polymorphic VT or ventricular fibrillation (VF) in 11 (61%) patients. Patients with appropriate ICD therapies were more likely to have a history of SCA (p = 0.003) and/or low left ventricular ejection fraction (LVEF) (p = 0.022) before ICD implantation as compared to patients without appropriate ICD therapies.

Conclusions

In our cohort of patients with MAD and ICD, appropriate ICD therapies were common. Most appropriate ICD therapies were delivered for polymorphic VT or VF. Larger studies are needed to elucidate the mechanisms of VAs and refine risk stratification in MAD.

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二尖瓣环分离和植入式心律转复除颤器患者的预后。

背景：二尖瓣环分离（MAD）可增加发生复杂室性心律失常的风险，从而导致心源性猝死。许多患者接受植入式心律转复除颤器（ICD）植入，但其ICD结果尚不清楚。目的：本研究的目的是评估MAD患者ICD植入的结果和适当的ICD治疗的预测因素。方法：研究对象为行ICD植入的MAD患者。收集临床、心电图、心脏成像和器械治疗数据。结果：纳入49例MAD合并ICD患者。中位年龄49（21）岁，女性29（59%）。13例（27%）患者为一级预防植入ICD， 36例（73%）患者为二级预防植入ICD。在27.3（35.3）个月的中位随访中，23例（47%）患者接受了ICD治疗。18例（37%）患者接受了适当的ICD治疗，5例（10%）患者接受了不适当的ICD电击。首次适当治疗的中位时间为22.3（63.3）个月。在二级预防ICD指征的患者中，适当的ICD治疗率为44%，而在一级预防ICD指征的患者中，这一比例为15%。在接受适当ICD治疗的患者中，7例（39%）患者接受了单形态室性心动过速（VT）的首次治疗，11例（61%）患者接受了多形态室性心动过速或心室颤动（VF）的首次治疗。与未接受适当ICD治疗的患者相比，接受适当ICD治疗的患者在ICD植入前更有可能有SCA病史（p = 0.003）和/或低左室射血分数（LVEF）（p = 0.022）。结论：在我们的MAD和ICD患者队列中，适当的ICD治疗是常见的。最合适的ICD治疗是针对多形态VT或VF。需要更大规模的研究来阐明VAs的机制并完善MAD的风险分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Electrophysiology 医学-心血管系统

CiteScore

5.20

自引率

14.80%

发文量

433

审稿时长

3-6 weeks

期刊介绍： Journal of Cardiovascular Electrophysiology (JCE) keeps its readership well informed of the latest developments in the study and management of arrhythmic disorders. Edited by Bradley P. Knight, M.D., and a distinguished international editorial board, JCE is the leading journal devoted to the study of the electrophysiology of the heart.