[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Current guidelines for the primary prevention of sudden cardiac death have used a left ventricular ejection fraction (LVEF) ≤35% as a critical point to justify implantable cardioverter defibrillator (ICD) implantation in post myocardial infarction patients and in those with nonischemic dilated cardiomyopathy. We compared mortality and ICD activation rates among different ICD group recipients using a cut-off value for LVEF ≤35%. METHODS: We followed up for a mean period of 41.1months 495 ICD recipients (442 males, 65.6years old, 68.9% post myocardial infarction patients, 422 with LVEF≤35%). Prevention was considered primary in patients who fulfilled guidelines criteria or had inducible ventricular arrhythmia during programmed ventricular stimulation for patients with LVEF >35%. RESULTS: Over the course of the trial, 84 of 495 patients died; 69 experienced cardiac death (6 sudden) and 15 non cardiac death. ICD recipients with LVEF ≤35% compared to those with preserved LVEF (mean LVEF=43%) had a greater incidence of total mortality (18% vs. 11%, log rank p=0.028) and cardiac death (15.4% vs. 5.5%, log rank p=0.005). There was no difference in the incidence for appropriate device therapy between patients with LVEF ≤35% and those with LVEF >35% (56.9% vs. 65.8%, log rank p=0.93). In the multivariate analysis the presence of advanced New York Heart Association stage predicted both total mortality (HR=2.69, 95% CI 1.771-4.086) and cardiac death (HR=3.437, 95% CI 2.163-5.463). CONCLUSIONS: ICD therapy may protect heart failure patients at early stages from arrhythmic morbidity and mortality, based on an electrophysiology-guided risk stratification approach.
International journal of cardiology 04/2012; · 6.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: During nocturnal non-invasive ambulatory blood pressure monitoring (ABPM), inevitably an undesirable external stimulus due to pump noise and pressure produced by cuff inflation may affect the quality of sleep, influence the physiological nocturnal blood pressure fall and consequently affect dipping status. We sought to investigate whether blood pressure monitoring provokes awakenings and changes in sleep quality, blood pressure and/or heart rate.