{"id":"69a6a3a3c2df","type":"article","url":"https://hartvaat.nl/2022/03/08/periodieke-repolarisatiedynamiek-identificeert-icd-responders-bij-nicm-danish/","title":"Periodieke repolarisatiedynamiek identificeert ICD-responders bij NICM: DANISH","title_en":"Periodic Repolarization Dynamics Identifies ICD Responders in Nonischemic Cardiomyopathy: A DANISH Substudy.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["iaso-dcm"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.121.056464","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.121.056464","authors":["Rune Boas","Nikolay Sappler","Lukas von Stülpnagel","Mathias Klemm","Ulrik Dixen","Jens Jakob Thune","Steen Pehrson","Lars Køber","Jens C Nielsen","Lars Videbæk","Jens Haarbo","Eva Korup","Niels Eske Bruun","Axel Brandes","Hans Eiskjær","Anna M Thøgersen","Berit T Philbert","Jesper Hastrup Svendsen","Jacob Tfelt-Hansen","Axel Bauer","Konstantinos D Rizas"],"significance":6,"published":"2022-03-08","source_date":"2022-03-08","image":"","kennis":[],"congress":"","summary_en":"This DANISH substudy showed that periodic repolarization dynamics, an ECG-based marker of sympathetic activity, identifies patients with nonischemic cardiomyopathy who benefit from prophylactic ICD implantation, improving patient selection.","created":"2026-07-03T10:29:39Z","updated":"2026-07-03T13:28:46Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"DANISH substudie die periodieke repolarisatiedynamiek identificeert als voorspeller van ICD-respons bij niet-ischemische cardiomyopathie.","abstract_original":"BACKGROUND: Identification of patients with nonischemic cardiomyopathy who may benefit from prophylactic implantation of a cardioverter-defibrillator. We hypothesized that periodic repolarization dynamics (PRD), a marker of repolarization instability associated with sympathetic activity, could be used to identify patients who will benefit from prophylactic implantable cardioverter defibrillator (ICD) implantation. METHODS: We performed a post hoc analysis of DANISH (Danish ICD Study in Patients With Dilated Cardiomyopathy), in which patients with nonischemic cardiomyopathy, left ventricular ejection fraction (LVEF) ≤35%, and elevated NT-proBNP (N-terminal probrain natriuretic peptides) were randomized to ICD implantation or control group. Patients were included in the PRD substudy if they had a 24-hour Holter monitor recording at baseline with technically acceptable ECG signals during the night hours (00:00-06:00). PRD was assessed using wavelet analysis according to previously validated methods. The primary end point was all-cause mortality. Cox regression models were adjusted for age, sex, NT-proBNP, estimated glomerular filtration rate, LVEF, atrial fibrillation, ventricular pacing, diabetes, cardiac resynchronization therapy, and mean heart rate. We proposed PRD ≥10 deg2 as an exploratory cut-off value for ICD implantation. RESULTS: A total of 748 of the 1116 patients in DANISH qualified for the PRD substudy. During a mean follow-up period of 5.1±2.0 years, 82 of 385 patients died in the ICD group and 85 of 363 patients died in the control group (P=0.40). In Cox regression analysis, PRD was independently associated with mortality (hazard ratio [HR], 1.28 [95% CI, 1.09-1.50] per SD increase; P=0.003). PRD was significantly associated with mortality in the control group (HR, 1.51 [95% CI, 1.25-1.81]; P<0.001) but not in the ICD group (HR, 1.04 [95% CI, 0.83-1.54]; P=0.71). There was a significant interaction between PRD and the effect of ICD implantation on mortality (P=0.008), with patients with higher PRD having greater benefit in terms of mortality reduction. ICD implantation was associated with an absolute mortality reduction of 17.5% in the 280 patients with PRD ≥10 deg2 (HR, 0.54 [95% CI, 0.34-0.84]; P=0.006; number needed to treat=6), but not in the 468 patients with PRD <10 deg2 (HR, 1.17 [95% CI, 0.77-1.78]; P=0.46; P for interaction=0.01). CONCLUSIONS: Increased PRD identified patients with nonischemic cardiomyopathy in whom prophylactic ICD implantation led to significant mortality reduction."}