Clinical application of the fibrillation number in patients with an implantable cardioverter defibrillator

초록

Introduction: Although ventricular tachycardia/fibrillation (VT/VF) develops suddenly with catastrophic results, its prediction is limited. We tested the fibrillation number (FibN) for potential predictor of VT/VF using clinical data of implantable cardioverter-defibrillator (ICD) patients after validating the number by computational modeling. Methods: For clinical application of FibN, we used electrocardiography and echocardiography data: QRS width, QTc, and left ventricular (LV) end-systolic dimension (FibN(VT/VF1)) or LV end-diastolic dimension (FibN(VT/VF)2). We compared the maintenance duration of VT/VF for various FibN values using computational modeling, and tested FibN(VT/VF) in 142 patients with ICD for secondary prevention and 426 patients in age-sex matched control group (81.9% male, 56.1 +/- 12.3 years old). Results: 1. Computational results showed a positive correlation between VT/VF maintenance duration and FibN (R = 0.82, p <0.001). 2. FibN(VT/VF)S were significantly higher in patients with ICD than in control (both FibN(VT/VF)1 and FibNyt1vF2, p < 0.001). 3. Within ICD group, FibN(VT/VF) values were higher in patients with cardiomyopathy than those without (both FibN(VT/VF)1 and FibN(VT/VF)2, p < 0.001). 4. During 50 +/- 39 months follow-up period, the frequency of appropriate ICD therapy was higher in the high FibN(VT/VF) group (FibNvrivFl, p = 0.001; FibN(VT/VF)2, p = 0.002). Both FibN(VT/VF)1 (HR 2.51, 95%CI 1.48-4.24, p = 0.001) and FibN(VT/VF)2 (HR 2.11, 95%CI 1.25-3.55, p = 0.005) were independently associated with appropriate ICD therapy in multi-variate analyses. Conclusion: FibN(VT/VF), a parameter based on wavelength and heart size, correlates well with maintenance of VT/VF in computational modeling, and may have predictive value for VT/VF events in patients with ICD for secondary prevention. (C) 2014 Elsevier Ltd. All rights reserved.

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