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Transient local injury current in right ventricular electrogram after implantable cardioverter-defibrillator shock predicts heart failure progression
JACC - Journal of the American College of Cardiology, 08/24/09

Tereshchenko LG et al. – Transient local injury current (LIC) on bipolar near-field (NF) right ventricular (RV) electrogram (EGM) after induced ventricular fibrillation (VF) rescue implantable cardioverter-defibrillator (ICD) shock is associated with increased risk of congestive heart failure (CHF) progression, future hospitalizations due to CHF exacerbation, and subsequent heart failure death.

Methods

Study to identify an early marker of functional impairment after an ICD shock as a predictor of heart failure progression
Analysis of NF bipolar RV EGMs during induced VF and 10 s after rescue ICD shock
Subjects: 310 pts (mean age 59 ± 14.5 yrs, 219 men [71%]) with structural heart disease, NYHA functional class I to III, and implanted with single- or dual-chamber Medtronic ICD for primary (245 pts, 79%) or secondary prevention of sudden cardiac arrest
LIC on NF RV EGM defined as a deviation of EGM potential ≥1 mV or ≥15% of preceding R-wave peak-to-peak amplitude
Adjustment for baseline prognostic factors: ejection fraction, history of atrial fibrillation, diabetes mellitus

Results

During mean follow-up of 29.3 ± 15.0 mo, the combined endpoint of death or hospitalization due to CHF exacerbation in 40 pts (12.9%, or 5.3% per person-yr of follow-up)
LIC in 106 pts
In multivariate risk analysis, after adjustment for baseline prognostic factors and appropriate ICD shocks during follow-up, pts with observed LIC after induced VF rescue ICD shock at ICD implantation were more likely to die or to be hospitalized

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