Coronary embolism (CE) is an uncommon cause of acute myocardial infarction (AMI), representing around 3

BACKGROUND:Coronary embolism (CE) is an uncommon cause of non-atherosclerotic acute myocardial infarction (AMI). Although atrial fibrillation (AF) is the main cause of CE, evidence of clinical, biochemical, echocardiographic, angiographic findings and outcomes of AF CE is lacking. METHODS:We retrospectively analyzed 85 consecutive patients with CE that was diagnosed based on criteria encompassing clinical, angiographic and diagnostic imaging findings. We classified patients according to AF CE or non-AF CE. RESULTS:Forty-five patients presented with AF CE (53%). Patients with AF CE were older (76 ± 12 vs. 63 ± 14 years; p < 0.001) and had more often chronic kidney disease (24% vs. 5%; p = 0.01). AF CE had lower estimated glomerular filtration rate at admission (59 ± 18 vs. 77 ± 16 ml/min/1.73 m2; p < 0.001) and higher brain natriuretic peptide levels (512 ± 417 vs. 210 ± 479 pg/ml; p = 0.02). Coronary arteriography revealed a higher incidence of coronary artery obstruction in the AF CE group (73% vs. 38%; p = 0.001) without differences in interventional management. The AF CE group showed higher left atrial volume index (LAVI) (42 ± 15 vs. 25 ± 12 ml/m2; p < 0.001) and showed lower left atrium ejection fraction (LAEF) (32 ± 17 vs. 49 ± 17%; p = 0.001). In the multivariable analysis AF CE (OR 10 [95% CI 1.04-95; p = 0.046]) and LAEF (OR 0.94 [95% CI 0.88-0.99; p = 0.02]) were associated with worse in-hospital outcomes. Moreover, in the multivariable analysis, prior stroke (OR 12.5 [95% CI 1.1-137; p = 0.04]) and LAVI (OR 1.1 [95% CI 1.03-1.14; p = 0.003]) were independently associated with worse long-term outcomes. CONCLUSION:AF CE has specific characteristics compared to non-AF-CE and it is associated with more in-hospital events. Furthermore, atrial cardiopathy is associated with worse in-hospital and long-term outcomes in this setting.

Introducción y objetivosSe han desarrollado puntuaciones multiparamétricas para una mejor estratificación del riesgo en el síndrome de Brugada (SBr). Nuestro objetivo es validar 3 abordajes multiparamétricos (las escalas Delise, Sieira y Shanghai BrS) en una cohorte de pacientes con síndrome de Brugada y estudio electrofisiológico (EEF).MétodosPacientes diagnosticados de SBr y con un EEF previo entre 1998-2019 en 23 hospitales. Se utilizaron análisis mediante estadístico C y modelos de regresión de riesgos proporcionales de Cox.ResultadosSe incluyó en total a 831 pacientes con una media de edad de 42,8±13,1 años; 623 (75%) eran varones; 386 (46,5%) tenían patrón electrocardiográfico (ECG) tipo 1; 677 (81,5%) estaban asintomáticos y 319 (38,4%) tenían un desfibrilador automático implantable. Durante un seguimiento de 10,2±4,7 años, 47 (5,7%) sufrieron un evento cardiovascular. En la cohorte total, un ECG tipo 1 y síncope fueron predictivos de eventos arrítmicos. Todas las puntuaciones de riesgo se asociaron significativamente con los eventos. Las capacidades discriminatorias de las 3 escalas fueron discretas (particularmente al aplicarlas a pacientes asintomáticos). La evaluación de las puntuaciones de Delise y Sieira con diferente número de extraestímulos (1 o 2 frente a 3) no mejoró sustancialmente el índice c de predicción de eventos.ConclusionesEn el SBr, los factores de riesgo clásicos como el ECG y el síncope previo predicen eventos arrítmicos. El número de extraestímulos necesarios para inducir arritmias ventriculares influye en las capacidades predictivas del EEF. Las escalas que combinan factores de riesgo clínico con EEF ayudan a identificar las poblaciones con más riesgo, aunque sus capacidades predictivas siguen siendo discretas tanto en población general con SBr como en pacientes asintomáticos.

INTRODUCTION AND OBJECTIVES:Multiparametric scores have been designed for better risk stratification in Brugada syndrome (BrS). We aimed to validate 3 multiparametric approaches (the Delise score, Sieira score and the Shanghai BrS Score) in a cohort with Brugada syndrome and electrophysiological study (EPS).METHODS:We included patients diagnosed with BrS and previous EPS between 1998 and 2019 in 23 hospitals. C-statistic analysis and Cox proportional hazard regression models were used.RESULTS:A total of 831 patients were included (mean age, 42.8±13.1; 623 [75%] men; 386 [46.5%] had a type 1 electrocardiogram (ECG) pattern, 677 [81.5%] were asymptomatic, and 319 [38.4%] had an implantable cardioverter-defibrillator). During a follow-up of 10.2±4.7 years, 47 (5.7%) experienced a cardiovascular event. In the global cohort, a type 1 ECG and syncope were predictive of arrhythmic events. All risk scores were significantly associated with events. The discriminatory abilities of the 3 scores were modest (particularly when these scores were evaluated in asymptomatic patients). Evaluation of the Delise and Sieira scores with different numbers of extra stimuli (1 or 2 vs 3) did not substantially improve the event prediction c-index.CONCLUSIONS:In BrS, classic risk factors such as ECG pattern and previous syncope predict arrhythmic events. The predictive capabilities of the EPS are affected by the number of extra stimuli required to induce ventricular arrhythmias. Scores combining clinical risk factors with EPS help to identify the populations at highest risk, although their predictive abilities remain modest in the general BrS population and in asymptomatic patients.

implantable cardiac defibrillator (ICD) has been established as a therapy for malignant ventricular arrhythmias in patients at high risk of suffering them. Some studies suggest a possible relationship between the development of cancer and some prosthetic materials. Likewise, some investigations describe a higher incidence of cancer in patients with an ICD that suggest a potential relationship.Retrospective cohort study of patients that underwent implantation of an ICD in the Complejo Hospitalario de Navarra between 2000 and 2016. The follow-up finished in June 2018. Sociodemographic, comorbidities and oncological data was analysed. Cancer incidence rates were estimated and compared with the general population data and with data of a cohort of patients with reduced LVEF heart failure. Risk of cancer models were adjusted by competitive risk models.497 patients were included, mostly male (89.1%), with a mean age of 59.98 (14.98) years and a proportion of smokers of 67.6% and of ischaemic heart disease of 51.6%. The cancer incidence rate in the sample was 1230.9 per 100.000 person-year. In our study, features associated with cancer were older age, higher tobacco use and ischaemic cardiopathy.In our sample of ICD carriers the incidence of cancer is high. This finding mainly seems to be related to tobacco usage and higher age.

BACKGROUND A male predominance in Brugada syndrome (BrS) has been widely reported, but scarce information on female patients with BrS is available. OBJECTIVE The purpose of this study was to investigate clinical characteristics and long-term prognosis of women with BrS. METHODS A multicenter retrospective study of patients diagnosed with BrS and previous electrophysiological study (EPS) was performed. RESULTS Among 770 patients, 177 (23%) were female. At presentation, 150 (84.7%) were asymptomatic. Females presented less frequently with a type 1 electrocardiographic pattern (30.5% vs 55.0%; P <.001), had a higher rate of family history of sudden cardiac death (49.7% vs 29.8%; P <.001), and had less sustained ventricular arrhythmias (VAs) on EPS (8.5% vs 15.1%; P = .009). Genetic testing was performed in 79 females (45% of the sample) and was positive in 34 (19%). An implantable cardioverter-defibrillator was inserted in 48 females (27.1%). During mean (+/- SD) follow-up of 122.17 +/- 57.28 months, 5 females (2.8%) experienced a cardiovascular event compared to 42 males (7.1%; P = .04). On multivariable analysis, a positive genetic test (18.71; 95% confidence interval [CI] 1.82-192.53; P = .01) and atrial fibrillation (odds ratio 21.12; 95% CI 1.27-350.85; P = .03) were predictive of arrhythmic events, whereas VAs on EPS (neither with 1 or 2 extrastimuli nor 3 extrastimuli) were not. CONCLUSION Women with BrS represent a minor fraction among patients with BrS, and although their rate of events is low, they do not constitute a risk-free group. Neither clinical risk factors nor EPS predicts future arrhythmic events. Only atrial fibrillation and positive genetic test were identified as risk factors for future arrhythmic events.

Introduction and Objectives: implantable cardiac defibrillator (ICD) has been established as a therapy for malignant ventricular arrhythmias in patients at high risk of suffering them. Some studies suggest a possible relationship between the development of cancer and some prosthetic materials. Likewise, some investigations describe a higher incidence of cancer in patients with an ICD that suggest a potential relationship. Methods: Retrospective cohort study of patients that underwent implantation of an ICD in the Complejo Hospitalario de Navarra between 2000 and 2016. The follow-up finished in June 2018. Sociodemographic, comorbidities and oncological data was analysed. Cancer incidence rates were estimated and compared with the general population data and with data of a cohort of patients with reduced LVEF heart failure. Risk of cancer models were adjusted by competitive risk models. Results: 497 patients were included, mostly male (89.1%), with a mean age of 59.98 (14.98) years and a proportion of smokers of 67.6% and of ischaemic heart disease of 51.6%. The cancer incidence rate in the sample was 1230.9 per 100.000 person-year. In our study, features associated with cancer were older age, higher tobacco use and ischaemic cardiopathy. Conclusions: In our sample of ICD carriers the incidence of cancer is high. This finding mainly seems to be related to tobacco usage and higher age. (C) 2020 Elsevier Espafia, S.L.U. All rights reserved.

Catheter ablation of accessory pathways(AP) with bidirectional conduction may be challenging due to technical issues related with the AP’s anatomical disposition. We sought to describe a novel electro-anatomical technique (fusion mapping) which aims at depicting the entire AP’s anatomical course from the atrial toward the ventricular AP’s insertion in order to guide catheter ablation. Twenty consecutive patients undergoing catheter ablation of APs with confirmed bidirectional conduction were included 3Delectroanatomical mapping was used to depict the merged 10ms isochrone area of maximum precocity of both the ventricular and atrial signals during sinus rhythm and ventricular pacing/orthodromic tachycardia, respectively A ‘purely anatomically’-guided AP’s catheter ablation was performed thereafter within the depicted isochrone area. Acute bidirectional AP conduction block was achieved 4±1 7sec after the first radiofrequency energy pulse was delivered in all patients, with no acute AP re-conduction being registered during a 30±10 minutes post-ablation observation time No complications related to the procedure were documented After a mean follow-up period of 9±7 months no recurrences were documented Time to AP conduction block and acute/subacute reconnection indexes were superior in a retrospective matched population of patients undergoing AP ablation (p<0 001 and p=0 016, respectively). Fusion mapping can be incorporated as a safe and efficient technique for ablation of APs with bidirectional conduction.

The clinical impact of slow ventricular tachycardia (VT), occurring in patients carrying implantable cardiac defibrillators (ICD), is still under debate. From the UMBRELLA registry (multicenter, observational, and prospective study on patients with ICD), 659 episodes of slow VT were observed in 97 patients. Untreated slow VT (n = 93) had longer duration (23.7 min, CI95%: 10–39), compared with episodes treated effectively by anti-tachycardia pacing (ATP; n = 527; 0.32 min, IC95%: 0.22–0, 48) or shock (n = 39; 1 min, CI95%: 0.8–1.2). Despite of longer duration, the time to the first contact with the medical services was similar to those episodes treated by ATP (50 days [CI95%: 45–55] vs. 41 days [CI95%: 39–44]). However, both were significantly longer than the time observed in episodes treated with shock (10 days, CI95%: 6–15). This tendency was maintained with successive interrogations of the device (2nd and 3rd). There were no significant differences in mortality during follow-up (48 ± 16 months), neither other adverse outcomes, between patients who presented untreated slow TV and those who did not (log-rank p = 0.28). In a Cox regression analysis, the variable “presenting untreated episodes of slow VT” was not able to predict mortality. However, being in sinus rhythm (vs. atrial fibrillation, OR: 0.31, p = 0.009), narrower QRS (OR: 1.036, p = 0.037) and diabetes (OR 4.673, p = 0.049) appropriately predict survival. Untreated slow VT does not significantly worsen patient prognosis. Our results support the limitation of therapies to ATP only, thus avoiding therapies that have been associated with increased risk of morbidity and mortality.

BACKGROUND:Hypertrophic cardiomyopathy (HCM) carries an increased risk of sudden death due to ventricular arrhythmias (VAs). The implantable cardioverter-defibrillator (ICD) is a well-established therapy for treatment of VA. Monomorphic ventricular tachycardias (MVTs) are frequent in HCM patients and suitable for antitachycardia pacing (ATP) termination. OBJECTIVE:The purpose of this study was to describe ventricular tachycardia (VT) characteristics in a population of HCM patients with ICD and to study the effectiveness and safety of ATP for MVT. METHODS:Data were obtained from the multicenter prospective observational UMBRELLA trial, which included all patients with HCM and ICD followed by the CareLink Monitoring System. All episodes of VA were collected and analyzed. ATP effectiveness and safety were described, and factors related to ATP effectiveness were studied with generalized estimating equation (GEE) models. RESULTS:Among 251 patients followed for 47 months, 67 (26.7%) were implanted as secondary prevention. Fifty-six patients presented 326 episodes of VA (286 [87%] MVT). Mean cycle length was 312 ± 64 ms. Among 264 MVTs that received ICD therapy, 202 (76.5%) were ATP terminated. The first ATP burst was effective in 169 episodes (68.4%), and overall effectiveness of the first or second ATP burst was 73.8%. Multivariate GEE-adjusted analysis showed 2 variables related to ATP effectiveness: programming fast VT zone On vs Off (odds ratio [OR] 2.4; 95% confidence interval [CI] 1.5-5.2; P = .03) and programming ≥2 ATP bursts vs 1 burst only (OR 1.6; 95% CI 1.2-3.4; P = .04; and OR 2.9; 95% CI 1.8-6.3; P = .02; respectively). CONCLUSION:MVT is the predominant VA in HCM patients with ICD. ATP is highly effective in terminating the majority of MVTs, and its proved effectiveness should guide device selection and programming in order to avoid unnecessary high-energy shocks.

Introducción y objetivosEn España no se dispone de datos sobre la implantación de electrodos de desfibrilación. Registros internacionales han descrito en los últimos años un cambio en favor de los electrodos monobobina. El objetivo primario de nuestro estudio fue tratar de inferir cómo ha sido la implantación de electrodos de desfibrilación durante los últimos años en nuestro país. El objetivo secundario busca identificar diferencias entre ambos tipos de electrodos.MétodosSe analizaron datos de 4.131 pacientes españoles portadores de un desfibrilador automático implantable, incluidos consecutivamente en el registro UMBRELLA y seguidos remotamente mediante sistema CareLink, entre 2005 y 2016.ResultadosInicialmente la proporción de electrodos de desfibrilación monobobina era<10%. Desde el año 2014, la proporción de electrodos monobobina implantados ha ido aumentando progresivamente, hasta superar la proporción de electrodos bibobina en el año 2016 (51,8% frente a 48,2%). En cuanto a las complicaciones acaecidas durante el implante del dispositivo o durante el seguimiento, no se observaron diferencias significativas entre ambos tipos de electrodos, más allá de una mayor proporción de choques en el grupo bibobina (17,5% frente a 5,8%; p<0,001), estando dicho hallazgo probablemente muy influido por las antiguas y más agresivas programaciones de los desfibriladores.ConclusionesLa práctica clínica con desfibriladores ha ido cambiando tanto en la forma de implantar como en la forma de programar los dispositivos. En lo que a electrodos de desfibrilación se refiere, en nuestro registro se observó un cambio en la elección del tipo de electrodo de desfibrilación, ya que fueron los electrodos monobobina los implantados con más frecuencia en los últimos años.

Abstract Background NYHA functional class (FC) is used for selection of heart failure (HF) patients who are candidates to primary prevention (PP) implantable cardioverter defibrillator (ICD) therapy. However, FC is subjectively estimated and concerns about its real prognostic value are still present in this setting. Purpose To compare whether mortality and arrhythmic risk are different, in a cohort of HF patients undergoing PP ICD-only implant, according to their FC. Methods All HF patients with left ventricle ejection fraction (LVEF) ≤35%, undergoing first prophylactic ICD-only implant were collected from the UMBRELLA nationwide registry (2006–2015). The sample was divided into three groups: no symptoms (NYHA I), mildly symptomatic patients (NYHA II) and severely symptomatic (NYHA III) patients. Outcomes were studied as follow: all-cause death, cardiovascular mortality and arrhythmia free survival (surrogate marker of sudden cardiac death) defined as survival free of first appropriate ICD therapy delivered in ventricular fibrillation (VF) window. Arrhythmic events were collected by remote monitoring and reviewed by a committee of experts. Results Six hundred and twenty one patients were identified (61.1±11.4 years, 87.3% male). Distribution of study groups was as follow: 101 patients in NYHA I; 411 in NYHA II; and 109 in NYHA III. More symptomatic patients were older and had higher prevalence of atrial fibrillation (AF) and chronic kidney disease (CKD). Higher rates of optimal medical treatment were present among study groups (beta-blockers: 92.1%; ACEI or ARB: 86.8%; aldosterone antagonists: 60.2%). After a median follow-up of 4.2 years (IQR, 2.7–5.7 years) 126 patients died (event rate: 20.3%). All-cause mortality was higher in patients with worse FC (13.9% vs. 18.3% vs. 32.9% for NYHA I, II and III respectively; p<0.001, log-rank test). Seventy-eight out of 126 deaths were related to cardiovascular causes (overall event rate: 12.6%). Cardiovascular mortality risk was also higher in more symptomatic patients (6.9% vs. 11% vs. 23.9% for NYHA I, II and III respectively; p<0.001, log-rank test). One hundred and seventeen patients received afirst appropriate ICD therapy (19.4%). Arrhythmia free survival was not different among study groups (20.8% vs. 18.7% vs. 20.8% for NYHA I, II and III, respectively; p=0.495, log-rank test). Cumulative incidence curves for the three outcomes are shown in Figure 1. After multivariate analysis, worse NYHA class independently predicted cardiovascular mortality but not all-cause death. Moreover, diabetes, AF and CKD strongly predicted both all-cause and cardiovascular mortality. Figure 1 Conclusions In HF patients, prophylactic ICD seems to be useful in preventing death due to life threatening arrhythmias, regardless of the baseline FC. Nevertheless, the combination of NYHA class with other comorbidities may be useful to select those ICD candidates who obtain less survival benefit.

Comparisons of the efficacy of dual- vs. single-chamber implantable cardioverter defibrillators (ICDs) in preventing inappropriate shocks have had contradictory results. We investigated whether dual-chamber devices have a lower risk of inappropriate shocks and the specific role of supraventricular tachycardia (SVT) discriminators.

BACKGROUND:Concerns about the efficacy of prophylactic ICD in non-ischemic cardiomyopathy (NICM) heart failure (HF) patients are still present. We aimed to assess whether survival and arrhythmic risk were different among ischemic cardiomyopathy (ICM) and NICM ICD-only patients, along with specific predictors for mortality.METHODS:HF patients undergoing ICD-only implant were extracted from the nationwide multicenter UMBRELLA registry. Arrhythmic events were collected by remote monitoring and reviewed by a committee of experts.RESULTS:782 patients (556 ICM; 226 NICM) were recruited: mean ejection fraction of 26.6%; 83.4% in NYHA class II-III; mean QRS duration of 108.9 ms (only 14.9% with QRS > 130 ms). After 4.35 years of mean follow-up, all-cause mortality rate was 4.2%/year. In propensity-score (PS) analysis no survival differences between ICM and NICM subgroups appeared (mortality rates: 19.4% vs. 20%, p = 0.375). Age (hazard ratio [HR] = 1.02, p = 0.009), diabetes (HR = 2.61, p ≤ 0.001), chronic obstructive pulmonary disease (HR = 2.13, p = 0.002), and previous HF (HR = 2.28, p = 0.027) correlated with increased mortality for the entire population, however atrial fibrillation (AF) (HR = 2.68, p = 0.002) and chronic kidney disease (HR = 3.74, p ≤ 0.001) emerged as specific predictors in NICM patients. At follow-up, 134 patients (17.1%) were delivered a first appropriate ICD therapy (5.1%/year) without significant differences between ICM and NICM patients in the PS analysis (17.6% vs. 15.8%, p = 0.968). ICD shocks were associated with a higher mortality (HR = 2.88, p < 0.001) but longer detection windows (HR = 0.57, p = 0.042) correlated with fewer appropriate therapies.CONCLUSIONS:Mortality and arrhythmia free survival is similar among ICM and NICM HF patients undergoing ICD-only implant for primary prevention strategy.

AIMS:Cardiac resynchronization therapy (CRT) reduces the incidence of sudden cardiac death and the use of appropriate implantable cardioverter-defibrillator (ICD) therapies (AICDTs); however, this antiarrhythmic effect is only observed in certain groups of patients. To gain insight into the effects of CRT on ventricular arrhythmia (VA) burden, we compared the incidence of AICDT use in four groups of patients: patients with ischaemic cardiomyopathy vs. non-ischaemic dilated cardiomyopathy (NIDC) and patients implanted with an ICD vs. CRT-ICD.METHODS AND RESULTS:We analysed 689 consecutive patients (mean follow-up 37 ± 16 months) included in the Umbrella registry, a multicentre prospective registry including patients implanted with ICD or CRT-ICD devices with remote monitoring capabilities in 48 Spanish Hospitals. The primary outcome was the time to first AICDT. Despite a worse clinical risk profile, NIDC patients receiving a CRT-ICD had a lower cumulative probability of first AICDT use at 2 years compared with patients implanted with an ICD [24.7 vs. 41.6%, hazard ratio (HR): 0.49, P = 0.003]; on the other hand, there were no significant differences in the incidence of first AICDT use at 2 years in ischaemic patients (22.6 vs. 21.9%, P = NS). Multivariate analysis confirmed the association of CRT with lower AICDT rates amongst NIDC patients (Adjusted HR: 0.55, CI 95% 0.35-0.87).CONCLUSIONS:These data suggest that CRT is associated with significantly lower rates of first AICDT use in NIDC patients, but not in ischaemic patients. This study suggests that ICD patients with NIDC and left bundle branch block experiencing VAs may benefit from an upgrade to CRT-ICD despite being in a good functional class.

Introduction and objectives: Fast ventricular tachycardias in the ventricular fibrillation zone in patients with an implantable cardioverter-defibrillator are susceptible to antitachycardia pacing (ATP) termination. Some manufacturers allow programming 2 ATP bursts: before charging (BC) and during (DC) charging. The aim of this study was to describe the safety and effectiveness of ATP BC and DC for fast ventricular tachycardias in the ventricular fibrillation zone in patients with an implantable cardioverter-defibrillator in daily clinical practice. Methods: Data proceeded from the multicenter UMBRELLA trial, including implantable cardioverter-defibrillator patients followed up by the CareLink monitoring system. Fast ventricular tachycardias in the ventricular fibrillation zone until a cycle length of 200 ms with ATP BC and/or ATP DC were included. Results: We reviewed 542 episodes in 240 patients. Two ATP bursts (BC/DC) were programmed in 291 episodes (53.7%, 87 patients), while 251 episodes (46.3%, 153 patients) had 1 ATP burst only DC. The number of episodes terminated by 1 ATP DC was 139, representing 55.4% effectiveness (generalized estimating equation-adjusted 60.4%). There were 256 episodes terminated by 1 or 2 ATP (BC/DC), representing 88% effectiveness (generalized estimating equation-adjusted 79.3%); the OR for ATP effectiveness BC/DC vs DC was 2.5, 95%Cl, 1.5-4.1; P < .001. Shocked episodes were 112 (45%) for ATP DC vs 35 (12%) for ATP BC/DC, representing an absolute reduction of 73%. The mean shocked episode duration was 16 seconds for ATP DC vs 19 seconds for ATP BC/DC (P = .07). Conclusions: The ATP DC in the ventricular fibrillation zone for fast ventricular tachycardia is moderately effective. Adding an ATP burst BC increases the overall effectiveness, reduces the need for shocks, and does not prolong episode duration. (C) 2017 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

implantations and the percentage of implantations performed as primary prophylaxis were obtained for each of the 5 Danish regions and 98 municipalities.Standardized implantation rates (SIRs) were computed as the number of implantations per 1,000,000 person-years, and age-and sex-standardized to the total population in Denmark during 2007-2013.Results: A total of 7,192 ICD recipients were identified.Figure 1 illustrates the SIRs in the regions and municipalities in Denmark during 2007-2013.The overall SIR was 186 (95% confidence interval [CI]: 182-190) implantations per 1,000,000 personyears, ranging from 170 (95% CI: 158-183) in the North Region to 207 (95% CI: 196-218) in the Region of Zealand.The proportion of implantations performed as primary prophylaxis was 37.0%, ranging from 27.3% in the North Region to 43.9% in the Region of Zealand.Conclusion: This nationwide study shows that, even in a small country with high demographic and socioeconomic homogeneity, ICD implantation rates and indications vary significantly between regions.P1744

Aims Coronary artery spasm (CAS) is associated with ventricular arrhythmias (VA). Much controversy remains regarding the best therapeutic interventions for this specific patient subset. We aimed to evaluate the clinical outcomes of patients with a history of life-threatening VA due to CAS with various medical interventions, as well as the need for ICD placement in the setting of optimal medical therapy. Methods and results A multicentre European retrospective survey of patients with VA in the setting of CAS was aggregated and relevant clinical and demographic data was analysed. Forty-nine appropriate patients were identified: 43 (87.8%) presented with VF and 6 (12.2%) with rapid VT. ICD implantation was performed in 44 (89.8%). During follow-up [59 (17-117) months], appropriate ICD shocks were documented in 12. In 8/12 (66.6%) no more ICD therapies were recorded after optimizing calcium channel blocker (CCB) therapy. SCD occurred in one patient without ICD. Treatment with beta-blockers was predictive of appropriate device discharge. Conversely, non-dihydropyridine CCB therapy was significantly protective against VAs. Conclusion Patients with life-threatening VAs secondary to CAS are at particularly high-risk for recurrence, especially when insufficient medical therapy is administered. Non-dihydropyridine CCBs are capable of suppressing episodes, whereas beta-blocker treatment is predictive of VAs. Ultimately, in spite of medical intervention, some patients exhibited arrhythmogenic events in the long-term, suggesting that ICD implantation may still be indicated for all.