open access
Prognostic impact of age and gender on patients with electrical storm
Affiliations- Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
- Department of Cardiology, Carl-Thiem-Klinikum Cottbus, Germany
- Department of Nuclear Medicine, University Hospital Heidelberg, Germany
- Department of Cardiology and Angiology II, University Heart Center Freiburg, Bad Krozingen, Germany
open access
Abstract
Background: Electrical storm (ES) is a severe and life-threatening heart rhythm disorder. Age and male gender have been identified as independent risk factors for cardiovascular diseases. However, data regarding the prognostic impact of age and gender on ES patients is limited. Methods: The present study included retrospectively consecutive patients presenting with ES from 2002 to 2016. Patients 67 years old or older were compared to patients younger than 67, males were also compared to females. Receiver operating characteristic analyses were performed to find the optimum age cut-off value. The primary endpoint was all-cause mortality at 3 years. The secondary endpoints were in-hospital mortality, rehospitalization rates, electrical storm recurrences (ES-R), and major adverse cardiac events (MACE) at 3 years. Results: Eighty-seven ES patients with implantable cardioverter-defibrillators were included. Age ≥ 67 years was associated with increased all-cause mortality at 3 years (48% vs. 20%, hazard ratio = 3.046; 95% confidence interval 1.316–7.051; p = 0.008; log-rank p = 0.006). MACE, in-hospital mortality, rehospitalization rates, and ES-R were not affected by age. Even after multivariate adjustment, age ≥ 67 years was associated with increased long-term mortality at 3 years, besides left ventricular ejection fraction < 35%. In contrast, gender was not associated with the primary and secondary endpoints. Conclusions: Patients 67 years old and older presenting with ES are associated with poor long-term prognosis at 3 years. Increased long-term mortality was still evident after multivariate adjustment. In contrast, gender was not associated with the primary and secondary endpoints.
Abstract
Background: Electrical storm (ES) is a severe and life-threatening heart rhythm disorder. Age and male gender have been identified as independent risk factors for cardiovascular diseases. However, data regarding the prognostic impact of age and gender on ES patients is limited. Methods: The present study included retrospectively consecutive patients presenting with ES from 2002 to 2016. Patients 67 years old or older were compared to patients younger than 67, males were also compared to females. Receiver operating characteristic analyses were performed to find the optimum age cut-off value. The primary endpoint was all-cause mortality at 3 years. The secondary endpoints were in-hospital mortality, rehospitalization rates, electrical storm recurrences (ES-R), and major adverse cardiac events (MACE) at 3 years. Results: Eighty-seven ES patients with implantable cardioverter-defibrillators were included. Age ≥ 67 years was associated with increased all-cause mortality at 3 years (48% vs. 20%, hazard ratio = 3.046; 95% confidence interval 1.316–7.051; p = 0.008; log-rank p = 0.006). MACE, in-hospital mortality, rehospitalization rates, and ES-R were not affected by age. Even after multivariate adjustment, age ≥ 67 years was associated with increased long-term mortality at 3 years, besides left ventricular ejection fraction < 35%. In contrast, gender was not associated with the primary and secondary endpoints. Conclusions: Patients 67 years old and older presenting with ES are associated with poor long-term prognosis at 3 years. Increased long-term mortality was still evident after multivariate adjustment. In contrast, gender was not associated with the primary and secondary endpoints.
Keywords
electrical storm, age, gender, long-term mortality
About this articleTitle
Prognostic impact of age and gender on patients with electrical storm
Journal
Issue
Article type
Original Article
Published online
2023-01-16
Page views
103
Article views/downloads
54
DOI
10.5603/CJ.a2023.0003
Pubmed
Keywords
electrical storm
age
gender
long-term mortality
Authors
Kathrin Weidner
Tobias Schupp
Jonas Rusnak
Julian Müller
Gabriel Taton
Linda Reiser
Armin Bollow
Thomas Reichelt
Dominik Ellguth
Niko Engelke
Max Barre
Dirk Große Meininghaus
Jorge Hoppner
Ibrahim El-Battrawy
Kambis Mashayekhi
Ibrahim Akin
Michael Behnes
References (24)- Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. ESC Scientific Document Group. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J. 2022; 43(40): 3997–4126.
- Israel CW, Barold SS. Electrical storm in patients with an implanted defibrillator: a matter of definition. Ann Noninvasive Electrocardiol. 2007; 12(4): 375–382.
- Gadula-Gacek E, Tajstra M, Gąsior M. Electrical storm - still an extremely poor prognosis. Do these acute states of life-threatening arrhythmias require a multidirectional approach from the start? Post Kardiol Interw. 2019; 15(1): 1–12.
- Hendriks AA, Szili-Torok T. Editor's Choice-The treatment of electrical storm: an educational review. Eur Heart J Acute Cardiovasc Care. 2018; 7(5): 478–483.
- Goyal P, Rich MW. Electrophysiology and heart rhythm disorders in older adults. J Geriatr Cardiol. 2016; 13(8): 645–651.
- Hamczyk MR, Nevado RM, Barettino A, et al. Biological versus chronological aging: JACC Focus Seminar. J Am Coll Cardiol. 2020; 75(8): 919–930.
- Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2018; 72(14): e91–e220.
- Chen J, Hocini M, Larsen TB, et al. Clinical management of arrhythmias in elderly patients: results of the European Heart Rhythm Association survey. Europace. 2015; 17(2): 314–317.
- Leal MA, Field ME, Page RL. Ventricular arrhythmias in the elderly: evaluation and medical management. Clin Geriatr Med. 2012; 28(4): 665–677.
- McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42(36): 3599–3726.
- Mendelsohn M. Protective effects of estrogen on the cardiovascular system. Am J Cardiol. 2002; 89(12): 12–17.
- Ng YY, Wah W, Liu N, et al. Associations between gender and cardiac arrest outcomes in Pan-Asian out-of-hospital cardiac arrest patients. Resuscitation. 2016; 102: 116–121.
- Suleiman M, Goldenberg I, Haim M, et al. Clinical characteristics and outcomes of elderly patients treated with an implantable cardioverter-defibrillator or cardiac resynchronization therapy in a real-world setting: data from the Israeli ICD Registry. Heart Rhythm. 2014; 11(3): 435–441.
- Yin J, Samawi H, Linder D. Improved nonparametric estimation of the optimal diagnostic cut-off point associated with the Youden index under different sampling schemes. Biom J. 2016; 58(4): 915–934.
- Yin J, Tian L. Joint confidence region estimation for area under ROC curve and Youden index. Stat Med. 2014; 33(6): 985–1000.
- Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Circulation. 2018; 138(20): e618–e651.
- Brigadeau F, Kouakam C, Klug D, et al. Clinical predictors and prognostic significance of electrical storm in patients with implantable cardioverter defibrillators. Eur Heart J. 2006; 27(6): 700–707.
- Guerra F, Shkoza M, Scappini L, et al. Role of electrical storm as a mortality and morbidity risk factor and its clinical predictors: a meta-analysis. Europace. 2014; 16(3): 347–353.
- Krahn AD, Connolly SJ, Roberts RS, et al. Diminishing proportional risk of sudden death with advancing age: implications for prevention of sudden death. Am Heart J. 2004; 147(5): 837–840.
- Lakatta EG. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part III: cellular and molecular clues to heart and arterial aging. Circulation. 2003; 107(3): 490–497.
- (Destatis), S.B. Sterbefälle Deutschland im Jahr 2015 anhand zweier Altersgruppen (Einwohner 40-60 Jahre und Einwohner > 60 Jahre). 2021.
- Sangaralingham SJ, Huntley BK, Martin FL, et al. The aging heart, myocardial fibrosis, and its relationship to circulating C-type natriuretic Peptide. Hypertension. 2011; 57(2): 201–207.
- González A, Fortuño MA, Querejeta R, et al. Cardiomyocyte apoptosis in hypertensive cardiomyopathy. Cardiovasc Res. 2003; 59(3): 549–562.
- Smer A, Saurav A, Azzouz MS, et al. Meta-analysis of risk of ventricular arrhythmias after improvement in left ventricular ejection fraction during follow-up in patients with primary prevention implantable cardioverter defibrillators. Am J Cardiol. 2017; 120(2): 279–286.
