The Effect of Spironolactone in Reducing Ventricular Arrhythmia in ICD-Implanted Patients (pp. 61-68)
Authors: Chonthicha Tanking and Thoranis Chantrarat
Abstract: Background: In patients with implantable cardioverter defibrillator (ICD), ventricular arrhythmia could lead to device shock, resulting in deleterious effects such as mortality and heart failure hospitalizations. The beneficial effect of spironolactone in reducing incidence of ventricular arrhythmia has been proposed. However, there is still insufficient confirmed evidence to prove this hypothesis.
Subjects and methods: This prospective cohort study was performed with data collection from patients who presented at heart clinic. Patients implanted with defibrillator, left ventricular ejection fraction less than 50%, functional class I-III were enrolled.
Results: A total of 110 patients were included. There were 48 patients in spironolactone group and 62 patients in non-spironolactone group. Mean follow-up time was about 6 months. The incidence rate ratio (IRR) of total episodes was significantly lower in the spironolactone group (IRR = 0.65 (95%CI 0.57-0.74, p-value < 0.001). The same trend was observed for NSVT and VT (IRR = 0.66, 0.36 with p < 0.001, 0.012, respectively). The IRR of ICD related total therapies was lower in the spironolactone group, with no statistical significance (IRR = 0.55, p = 0.156). Left ventricular ejection fraction less than 35%, male gender, advanced age, diabetes and hypertension were significant risk factors for developing ventricular arrhythmia events.
Conclusion: In implantable cardioverter defibrillator implanted patients with left ventricular dysfunction, spironolactone could be a protective factor for a significant reduction of ventricular arrhythmia events. There is a trend towards lower total therapy. Risk factors for developing ventricular arrhythmia events are left ventricular ejection fraction less than 35%, male gender, advanced age, diabetes and hypertension.
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