Prognostic role of left atrial enlargement in patients with implantable cardioverter defibrillators for primary prevention

Abstract

Purpose

Left atrial volume index (LAVI) is a predictor of heart failure and adverse events, irrespective of left ventricular systolic function. The role of LAVI in the prediction of appropriate implantable cardioverter-defibrillator (ICD) therapies is currently unclear and was the focus of this study.

Methods

Consecutive heart failure patients with ischaemic (ICM) or idiopathic (DCM) aetiology receiving ICD for primary prevention were included. The primary endpoint was the occurrence of appropriate ICD therapies (ATs): shocks or antitachycardia pacing (ATP). Inappropriate ICD shocks were also assessed as secondary endpoint.

Results

Among 198 included patients, severe left atrial dilatation (SLAE = LAVI ≥ 60 ml/m²) was present in 54 (27%). SLAE patients had a higher prevalence of NYHA class ≥ III, severe mitral regurgitation and atrial fibrillation history. During a median follow-up of 45 months (IQR 25–68), ATs occurred more frequently in SLAE group (33% vs. 15%, p = .007) as well as appropriate shocks (24% vs. 10%, p = .014). At multivariate analysis SLAE was an independent predictor of ATs (OR 3.19, 95% CI 1.38–7.38, p = .007). Inappropriate shocks were associated with AF during implantation (p = .03), but not with SLAE (p = .009).

Conclusion

In DCM or ICM patients candidate to receive an ICD for primary prevention, a severely enlarged left atrium is a predictive factor for ATs (shocks or ATP). The risk of inappropriate shocks was increased in patients with atrial fibrillation, rather than SLAE.

Keywords:

• ICD
• primary prevention
• left atrial volume index
• atrial dilatation
• shock
• inappropriate shock

Ethical approval

The SPIKE Registry protocol was evaluated and accepted by the Ethics Committee of the Città della Salute e della Scienza. Patients have given written consent to the inclusion of clinical and fully anonymized data.

Disclosure statement

The authors declare they have no conflict of interest.