Creatinine and Defibrillation Threshold among Patients with Congestive Heart Failure with a Biventricular ICD: Is There a Correlation?
Introduction: Preliminary data suggest that ICD recipients have a direct relationship between worsening renal failure and higher DFT. Additionally, Biventricular ICD patients have poorer survival if they have associated kidney disease. Exact mechanism of this relationship is undefined. We sought to study the relationship between creatinine and defibrillation threshold among CHF patients who receive biventricular ICD. Methods: Two hundred and fifty consecutive patients who underwent biventricular ICD implantation at Good Samaritan Hospital, Dayton, OH and St. Rita's Medical Center, Lima, OH were included in the study. The study population was categorized into two levels of creatinine (1.5 mg/dL or lower, n = 166 vs. 1.6mg/dL or higher, n = 61). Results: Baseline characteristics showed that higher creatinine group consisted of older patients with a mean difference of 5.47 years (p = <0.001) and their mean LVEF was lower by 2.42%. The higher creatinine group were more likely to be males, less likely to be taking ACE-inhibitors/ARB and more likely to be taking amiodarone. DFT's were 16.75 + /-6.13 Joules in the higher creatinine group vs 14.14 + /-4.8 Joules in the lower creatinine group (p = .003). For 228 patients where the data for both DFT and creatinine was available, the Pearson correlation between creatinine and DFT was .126 (p = 0.057) Conclusion: The statistically significant mean difference of 2.6 joules between the two levels of creatinine may have clinical value in an individual patient where the DFT may be quite high. Future prospective studies should be designed which should be statistically powered to examine the relationship of higher DFT with worsening renal function.
& Hoersten, C.
(2010). Creatinine and Defibrillation Threshold among Patients with Congestive Heart Failure with a Biventricular ICD: Is There a Correlation?. Journal of Cardiac Failure, 16 (8), S63.