19. Sudden Death: ECG and Biological Risk Factors: 19.6 C-Reactive Protein is Associated with Malignant Ventricular Arrhythmias in Ischemic Patients with Implantable Cardioverter Defibrillator

Implantable Cardioverter Defibrillator (ICD) has been proven to reduce the risk of death in ischemic cardiomyopathy with low ejection fraction, mainly by reducing arrhythmic death. However any attempt to further predict the risk of arrhythmic death in this pts gave inconsistent results. C-reactive protein (CRP) is a marker of future events in ischemic heart disease and predicts the risk of future cardiac death, myocardial infarction, stroke and sudden death in ischemic patients. We sought to assess whether CRP levels, in pts with ICD, predict recurrence of appropriate ICD intervention for sustained ventricular tachycardia (VT) and/ or ventricular fibrillation (VF).

We enrolled 65 ICD recipients with a prior myocardial infarction and a left ventricular ejection fraction ≤30% (MADIT II –like criteria of inclusion). In all patients we measured CRP and, retrospectively, we determined the incidence of appropriate ICD therapies for TV/FV during the previous 12 months by reviewing ICD-stored electrograms.

during follow-up 18/65 (28%) patients had VT/VF triggering ICD therapy. Twenty-nine out 65 pts had CRP levels >3mg/L (median and range: 6.2; 3.15-74) and 36 had CRP<3mg/L (median and range: 1.5; 0.3-2.7). Fourteen out of 29 pts with CRP>3 mg/L had VT/VF, vs only 4/36 (11%) of those with CRP<3 mg/L (p<0.003). CRP levels were (median and range) 5.12 mg/L (0,3-74) in the 18 pts with VT/VF and 2.0 (0.4-26) in the 47 without events. In a logistic regression analysis CRP was independently associated with occurrence of VT/VF (OR 2.4, CI 1.1-5.24).

Our results suggest that CRP levels >3mg/L are associated with recurrence of VT/VF in patients with ICD (MADIT II-like criteria of inclusion). This may have implications for future risk assessment of patients with potential benefit from ICD implantation.