A Decision Tree-Based Survival Analysis of Patients with a History of Inappropriate Implantable Cardioverter-Defibrillator Therapy
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- Yamamoto Masaru
- Department of Laboratory Medicine, Fujita Health University Hospital
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- Okajima Katsunori
- Department of Cardiology, Himeji Cardiovascular Center
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- Shimane Akira
- Department of Cardiology, Himeji Cardiovascular Center
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- Ozawa Tomoya
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
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- Morishima Itsuro
- Department of Cardiology, Ogaki Municipal Hospital
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- Asai Toru
- Department of Cardiology, Ichinomiya Municipal Hospital
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- Takagi Masahiko
- Division of Cardiac Arrhythmia, Cardiovascular Center, Department of Medicine II, Kansai Medical University
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- Kasai Atsunobu
- Department of Cardiology, Ise Red Cross Hospital
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- Fujii Eitaro
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
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- Kiyono Ken
- Division of Bioengineering, Graduate School of Engineering Science, Osaka University
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- Watanabe Eiichi
- Department of Cardiology, Fujita Health University School of Medicine
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- Ozaki Yukio
- Department of Cardiology, Fujita Health University School of Medicine
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Abstract
<p>Implantable cardioverter-defibrillators (ICDs) improve survival in patients who are at risk of sudden death. However, inappropriate therapy is commonly given to ICD recipients, and this situation may be associated with an increased risk of death. This study aimed to construct a risk stratification scheme by using decision tree analysis in patients who received inappropriate ICD therapy.</p><p>Mortality was calculated from a retrospective data analysis of a multicenter cohort involving 417 ICD recipients. Inappropriate therapy was defined as therapy for nonventricular arrhythmias, including sinus tachycardia, supraventricular tachycardia, atrial fibrillation/flutter, oversensing, and lead failure. Inappropriate therapy included antitachycardia pacing, cardioversion, and defibrillation. The prognostic factors were identified by a Cox proportional hazards regression analysis, and we constructed a decision tree.</p><p>During an average follow-up of 5.2 years, 48 patients (12%) had all-cause death. A multivariate Cox hazard model revealed that the age (hazard ratio [HR] 1.06, P < 0.001), ln B-type natriuretic peptide (BNP) (HR 1.47, P = 0.02), nonsinus rhythm at implantation (HR 2.70, P < 0.05), and inappropriate therapy occurring during sedentary/awake conditions (HR 3.51, P = 0.001) correlated with an increased risk of mortality. An inappropriate therapy due to abnormal sensing (HR 0.16, P = 0.04) decreased the risk of mortality. Furthermore, a decision tree analysis stratified the patients well by using 4 covariates: BNP, activity at the time of inappropriate therapy, mechanism of inappropriate therapy, and baseline rhythm at ICD implantation (log-rank test, P < 0.0001).</p><p>We identified the predictors of mortality in inappropriate ICD therapy recipients and constructed a risk stratification scheme by using decision tree analysis.</p>
Journal
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- International Heart Journal
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International Heart Journal 60 (2), 318-326, 2019-03-30
International Heart Journal Association