Arrhythmias & electrophysiology
Frequency of and outcomes associated with nonadherence to guideline-based recommendations for an implantable cardioverter-defibrillator in patients with congenital long QT syndrome
Authors' conclusion
With >1200 years of combined follow-up, the experience and evidence from our 2 LQTS specialty centers suggest that many patients who satisfy a recommendation for an ICD based on the latest 2022 European Society of Cardiology guidelines may not need one.
Study context
- Population
- Patients with LQT1, LQT2 or LQT3 meeting a class I or II 2022 ESC guideline-based implantable cardioverter-defibrillator (ICD) recommendation290 met an ICD recommendation
- Participants
- 2,861 patients
- Exposure
- No ICD vs ICD
- ICDn = 134
- No ICDn = 156reference
- Outcome
- Frequency of guideline-based ICD recommendations and outcomes (BCEs, complications) with vs without ICD
Methodological details2 long QT syndrome (LQTS) specialty centres, >1200 years of combined follow-up
- 2 LQTS specialty centres
- >1200 years of combined follow-up
Main finding
As reported in the abstract
| Group | Value | ≥1 appropriate VF-terminating ICD therapy | Nonlethal breakthrough cardiac events (BCEs) |
|---|---|---|---|
| ICD | 41% | 55 of 134 (41%) | |
| No ICD | 4% | 6 of 156 (4%) |
Value
ICD41%
No ICD4%
≥1 appropriate VF-terminating ICD therapy
ICD55 of 134 (41%)
No ICDNot reported in the abstract
Nonlethal breakthrough cardiac events (BCEs)
ICDNot reported in the abstract
No ICD6 of 156 (4%)
- No ICD vs ICD: P < 0.001 — BCEs significantly lower without ICD
- Met a guideline-based ICD recommendation
- 290 (≈10%)
- Class I/level B indication
- 53 (18%)
- Class I/level C indication
- 56 (19%)
- Class IIa/level C indication
- 19 (7%)
- Class IIb/level B indication
- 162 (56%)
- Did not receive an ICD
- 156/290 [54%]
Observational data: associations, not effects.
Safety
- ICD-related complications
- 10% · 13 of 134
Original publication
Frequency of and outcomes associated with nonadherence to guideline-based recommendations for an implantable cardioverter-defibrillator in patients with congenital long QT syndrome. Heart Rhythm. Published 2 October 2024. doi:10.
Summarised from the published abstract; every number is checked against it