{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T04:42:00Z","timestamp":1786336920972,"version":"build-2736575974"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,3,19]]},"abstract":"\n Background<\/jats:title>\n \n Patients with heart failure and an implantable cardioverter\u2010defibrillator (\n ICD<\/jats:styled-content>\n ) for primary prevention are at increased mortality risk after receiving shock therapy. We sought to determine the prognostic significance of\n ICD<\/jats:styled-content>\n therapies, both shock and antitachycardia pacing, delivered for different ventricular arrhythmia (\n VA<\/jats:styled-content>\n ) rates.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We evaluated mortality risk among 1790\n ICD<\/jats:styled-content>\n \u2010implanted patients from\n MADIT<\/jats:styled-content>\n \u2010CRT (Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy). For the first analysis, patients were divided into mutually exclusive groups by the rate of treated\n VA<\/jats:styled-content>\n only: slow\n VA<\/jats:styled-content>\n (<200\u00a0beats per minute) and fast\n VA<\/jats:styled-content>\n (\u2265200\u00a0beats per minute or ventricular fibrillation). In a secondary analysis, both the type of\n ICD<\/jats:styled-content>\n therapy and\n VA<\/jats:styled-content>\n rate were used. The reference group was always patients who had no\n ICD<\/jats:styled-content>\n therapy.\n ICD<\/jats:styled-content>\n therapy for fast\n VA<\/jats:styled-content>\n was associated with increased mortality risk (hazard ratio [\n HR]<\/jats:styled-content>\n , 2.27; 95%\n CI<\/jats:styled-content>\n , 1.48\u20133.48;\n P<\/jats:italic>\n <0.001). However, mortality risk after\n ICD<\/jats:styled-content>\n therapy for slow\n VA<\/jats:styled-content>\n was similar to the risk related to no\n ICD<\/jats:styled-content>\n therapy (\n HR<\/jats:styled-content>\n , 1.45; 95%\n CI<\/jats:styled-content>\n , 0.86\u20132.44;\n P<\/jats:italic>\n =0.162). Consistently, shocks (\n HR<\/jats:styled-content>\n , 2.96; 95%\n CI<\/jats:styled-content>\n , 1.91\u20134.60;\n P<\/jats:italic>\n <0.001) and antitachycardia pacing (\n HR<\/jats:styled-content>\n , 2.22; 95%\n CI<\/jats:styled-content>\n , 0.96\u20135.14;\n P<\/jats:italic>\n =0.063) for fast\n VA<\/jats:styled-content>\n were both associated with increased mortality risk. Shocks and antitachycardia pacing for slow\n VA<\/jats:styled-content>\n were not significantly associated with increased mortality risk (\n HR<\/jats:styled-content>\n , 1.43 [95%\n CI<\/jats:styled-content>\n , 0.52\u20133.92;\n P<\/jats:italic>\n =0.489]; and\n HR<\/jats:styled-content>\n , 1.43 [95%\n CI,<\/jats:styled-content>\n 0.80\u20132.56;\n P<\/jats:italic>\n =0.232], respectively).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n In patients with mild heart failure receiving\n ICD<\/jats:styled-content>\n for primary prevention, mortality is associated with the rate of underlying\n VA<\/jats:styled-content>\n rather than the type of therapy. These findings suggest that fast\n VA<\/jats:styled-content>\n is a marker for increased mortality rather than shock therapy directly contributing to increased risk.\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL<\/jats:styled-content>\n :\n http:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n . Unique identifier:\n NCT<\/jats:styled-content>\n 00180271.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.010346","type":"journal-article","created":{"date-parts":[[2019,3,12]],"date-time":"2019-03-12T09:00:17Z","timestamp":1552381217000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Prognostic Importance of Defibrillator\u2010Appropriate Shocks and Antitachycardia Pacing in Patients With Mild Heart Failure"],"prefix":"10.1161","volume":"8","author":[{"given":"Yitschak","family":"Biton","sequence":"first","affiliation":[{"name":"Heart Research Follow\u2010Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NY"},{"name":"Massachusetts General Hospital Harvard Medical School Boston MA"},{"name":"Department of Cardiology Hadassah Medical Center Hadassah School of Medicine Hebrew University Jerusalem Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Usama A.","family":"Daimee","sequence":"additional","affiliation":[{"name":"Heart Research Follow\u2010Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jayson R.","family":"Baman","sequence":"additional","affiliation":[{"name":"Heart Research Follow\u2010Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NY"},{"name":"Department of Medicine Feinberg School of Medicine Northwestern University Chicago IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Kutyifa","sequence":"additional","affiliation":[{"name":"Heart Research Follow\u2010Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"McNitt","sequence":"additional","affiliation":[{"name":"Heart Research Follow\u2010Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bronislava","family":"Polonsky","sequence":"additional","affiliation":[{"name":"Heart Research Follow\u2010Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech","family":"Zareba","sequence":"additional","affiliation":[{"name":"Heart Research Follow\u2010Up Program Division of Cardiology Department of Medicine University of Rochester Medical Center Rochester NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilan","family":"Goldenberg","sequence":"additional","affiliation":[{"name":"Heart Research 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