Publications by authors named "Bronislava Polonsky"
Background: There are limited data on clinical and arrhythmic outcomes after a first ventricular tachyarrhythmia (VTA) in heart failure (HF) patients who receive a primary prevention implantable cardioverter-defibrillator (ICD).
Objective: This study was designed to quantify the burden of and to identify risk factors for recurrent VTA in this population and to evaluate the risk of all-cause mortality associated with recurrent VTA.
Methods: The study comprised 789 patients who experienced VTA following primary prevention ICD implantation in 5 ICD trials (MADIT-II, MADIT-RISK, MADIT-CRT, MADIT-RIT, RAID).
Risk stratification for ventricular tachyarrhythmia in patients with nonischemic cardiomyopathy.
J Cardiovasc Electrophysiol
January 2025
Introduction: The implantable cardioverter defibrillator reduces mortality among patients with heart failure (HF) due to ischemic heart disease. Clinical trial data have called into question the benefit of an ICD in patients with HF due to nonischemic cardiomyopathy (NICM). We developed a risk stratification score for ventricular tachyarrhythmia (VTA) among patients with NICM receiving a primary prevention ICD.
View Article and Find Full Text PDFBackground And Aims: Long QT syndrome (LQTS) and coronary artery disease (CAD) are both associated with increased risk of ventricular tachyarrhythmia However, there are limited data on the incremental risk conferred by CAD in adult patients with congenital LQTS. We aimed to investigate the risk associated with CAD and life threatening events (LTEs) in patients with LQTS after age 40 years.
Methods: The risk of LTEs (comprising aborted cardiac arrest, sudden cardiac death, or appropriate defibrillator shock) from age 40 through 75 years was examined in 1,020 subjects from the Rochester LQTS registry, categorized to CAD ( = 137) or no-CAD ( = 883) subgroups.
Digoxin and Risk of Ventricular Tachyarrhythmia and Death in ICD Recipients.
JACC Clin Electrophysiol
July 2024
Article Synopsis
- Some studies indicate that digoxin may lead to adverse health outcomes, including higher mortality rates in heart failure patients.
- This study aimed to determine if digoxin increases the risk of ventricular tachycardia (VT) or ventricular fibrillation (VF) in heart failure patients with implantable cardioverter-defibrillators (ICDs).
- The results showed that digoxin use significantly raised the risk of VT/VF by 48%, increased the risk of death by 37%, and led to more ICD shocks, highlighting potential dangers of digoxin in this patient group.
Article Synopsis
- This study analyzed sex differences in life-threatening heart conditions (ventricular tachycardia and ventricular fibrillation) among patients with implantable cardioverter-defibrillators (ICDs) who had previously experienced these issues.
- Results showed that women had a significantly lower risk of these events and death compared to men, as well as a reduced risk of recurrent VT/VF.
- Additionally, racial disparities were noted, with White women showing a much lower risk compared to White men, while Black women had similar risks to Black men.
Introduction: The implantable cardioverter defibrillator (ICD) is effective for the prevention of sudden cardiac death (SCD) in patients with heart failure and a reduced ejection fraction (HFrEF). The benefit of the ICD in patients with advanced CKD, remains elusive. Moreover, the benefit of the ICD in patients with advanced chronic kidney disease (CKD) and HFrEF who are cardiac resynchronization therapy (CRT) recipients may be attenuated.
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- Both selective (metoprolol) and nonselective (carvedilol) beta-blockers are used for heart failure (HF), but their impact on rhythm issues in patients with implantable cardioverter-defibrillators (ICD) is not well studied.
- * This research compared the effects of metoprolol and carvedilol on atrial tachyarrhythmia (ATA) and ventricular arrhythmia (VA) in HF patients with an ICD using data from five major trials.
- * Results showed that carvedilol was linked to a significantly lower risk of ATA and inappropriate ICD shocks compared to metoprolol, while also suggesting a slight reduction in fast VA risk, although this last finding wasn’t
Genetic variant annotation scores in congenital long QT syndrome.
Ann Noninvasive Electrocardiol
September 2023
Article Synopsis
- Congenital Long QT Syndrome (LQTS) is a genetic heart condition, and researchers investigated how well current genetic variant annotation tools predict cardiac risks in LQTS patients.
- Among 2025 patients studied, different algorithms showed varying success in identifying pathogenic mutations, with REVEL performing best at 100%.
- Despite these tools accurately identifying variants, they failed to predict cardiac events or life-threatening scenarios, highlighting the need to focus on mutation location and function for assessing risks associated with LQTS.
Article Synopsis
- Black Americans with nonischemic cardiomyopathy (NICM) have a higher risk of tachyarrhythmias and complications related to implantable cardioverter-defibrillators (ICDs) compared to White Americans.
- The study found that Black patients were younger, more likely to be female, and had more comorbidities, contributing to their increased risk for first ventricular tachyarrhythmias and ICD therapies.
- Despite the higher risks in NICM cases, both Black and White patients showed similar benefits from ICDs in ischemic cardiomyopathy.
Article Synopsis
- * This study analyzed data from 2938 patients across five international registries, focusing on the link between adrenergic (AD) and nonadrenergic (non-AD) triggered syncopal events and subsequent life-threatening risks.
- * Results showed that AD-triggered syncope significantly increased the risk of future life-threatening events, with a hazard ratio of 7.61, while non-AD triggered events did not show a significant risk increase.
Background: Black Americans have a higher risk of non-ischemic cardiomyopathy (NICM) than White Americans. We aimed to evaluate racial disparities in the risk of tachyarrhythmias among patients with an implantable cardioverter defibrillator (ICD).
Methods: The study population comprised 3,895 ICD recipients enrolled in the U.
Background: There are limited data regarding racial disparities in outcomes after left ventricular assist device (LVAD) implantation. The purpose of this study was to compare clinical characteristics and the burden of readmissions by race among patients with LVAD.
Methods: The study population included 461 patients implanted with LVADs at the University of Rochester Medical Center, NY from May 2008 to March 2020.
Background: The benefit of implantable cardioverter-defibrillators (ICDs) in elderly patients is controversial.
Objectives: The aims of this study were to evaluate the risk for ventricular tachyarrhythmia (VTA) and ICD shocks by age groups and to assess the competing risk for VTA and death without prior VTA.
Methods: The study included 5,170 primary prevention ICD recipients enrolled in 5 landmark ICD trials (MADIT [Multicenter Automatic Defibrillator Implantation Trial] II, MADIT-Risk, MADIT-CRT [MADIT Cardiac Resynchronization Therapy], MADIT-RIT [MADIT Reduce Inappropriate Therapy], and RAID [Ranolazine in High-Risk Patients With Implanted Cardioverter-Defibrillator]).
Background: Risk stratification in long QT syndrome (LQTS) patients is important for optimizing patient care and informing clinical decision making. We developed a risk prediction algorithm with prediction of 5-year absolute risk of the first life-threatening arrhythmic event [defined as aborted cardiac arrest, sudden cardiac death, or appropriate implantable cardioverter defibrillator (ICD) shock] in LQTS patients, accounting for individual risk factors and their changes over time.
Methods: Rochester-based LQTS Registry included the phenotypic cohort consisting of 1,509 LQTS patients with a QTc ≥ 470 ms, and the genotypic cohort including 1,288 patients with single LQT1, LQT2, or LQT3 mutation.
Background: Studies have reported sex differences in outcomes following implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy-defibrillator (CRT-D) implantation. However, little is known about sex differences with regard to mode of death or device efficacy following ICD or CRT-D implantation.
Objectives: The purpose of this study was to investigate whether sex influenced mode of death or device efficacy in ICD and CRT-D subjects enrolled in the MADIT (Multicenter Automatic Defibrillator Implantation Trial) studies (MADIT-II, MADIT-CRT, and MADIT-RIT).
Importance: Current guidelines for primary implantable cardioverter-defibrillator (ICD) therapy do not account for sex differences in arrhythmic risk in ICD candidates.
Objective: To evaluate the association between sex and risk of ventricular tachyarrhythmia (VTA) and mortality.
Design, Setting, And Participants: This cohort study compared differences in the risk of VTA and mortality between 4506 men and women enrolled in the 4 Multicenter Automatic Defibrillator Implantation Trials (MADIT) between July 1, 1997, and December 31, 2011.
Article Synopsis
- Current guidelines overlook potential sex differences in the risk of ventricular tachyarrhythmia (VTA), prompting a study focused on women with implantable cardioverter-defibrillators (ICDs).
- The research analyzed data from 4,506 patients across four major studies, finding that women had a significantly lower cumulative incidence of VTA (17% vs 26% in men) after 3.5 years of follow-up.
- Key risk factors for VTA in women included the use of amiodarone, Black race, and a history of myocardial infarction, with Black race being the only factor also significantly influencing men’s risk.
It has been suggested that maintaining low mean arterial pressure (MAP) in left ventricular assist device (LVAD) recipients is associated with a reduced risk of stroke/death. However, the lower limit of the optimal MAP range has not been established. We aimed to identify this lower limit in a contemporary cohort of LVAD recipients with frequent longitudinal MAP measurements.
View Article and Find Full Text PDFBackground: The effectiveness of implantable cardioverter-defibrillators (ICDs) on reducing mortality has not been well studied in patients with long QT syndrome (LQTS).
Objectives: This study aimed to assess the survival benefits of ICDs in the overall LQTS population and in subgroups defined by ICD indications.
Methods: This study included 3,035 patients (597 with ICD) from the Rochester LQTS Registry with a QTc ≥470 milliseconds or confirmed LQTS mutation.
Article Synopsis
- The study investigates the role of detailed genetic information in gauging the risk of arrhythmogenic right ventricular cardiomyopathy (ARVC), specifically focusing on the genetic variant plakophilin-2 (PKP2).
- Researchers used the Combined Annotation Dependent Depletion (CADD) score to evaluate the potential pathogenicity of genetic variants and their relationship with arrhythmic events and the onset of ARVC symptoms.
- Results showed no significant link between CADD scores and clinical outcomes in patients, suggesting that these scores do not enhance risk assessment for individuals with pathogenic PKP2 variants.
Background: Implantable cardioverter-defibrillator (ICD) programming to novel settings can reduce the risk of inappropriate therapies.
Objective: The purpose of this study was to evaluate the impact of novel ICD programming after the first occurrence of ventricular tachycardia (VT).
Methods: In MADIT-RIT (Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy) patients who experienced a first occurrence of VT, the risk of subsequent inappropriate and appropriate ICD therapies and adverse cardiovascular events by ICD programming to Arm A (conventional: VT ≥170 bpm), Arm B (high rate: VT ≥200 bpm), or Arm C (duration delay: ≥60-second delay before therapy ≥170 bpm) was determined.
There are limited data on the association of smoking with the risk of stroke following left ventricular assist device (LVAD) implantation. We designed this study to analyze the impact of smoking status at the time of LVAD implantation on stroke. We hypothesized that current smokers are at increased risk of stroke when compared with patients who were former or never smokers.
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- The study explores the relationship between implantable cardioverter-defibrillator (ICD) shocks and subsequent mortality among 5,516 ICD recipients from major clinical trials.
- It finds that receiving appropriate ICD shocks, particularly for life-threatening arrhythmias like ventricular tachycardia and ventricular fibrillation, is linked to an increased risk of dying afterward.
- Inappropriate shocks did not show a significant effect on mortality, suggesting that the types of arrhythmias treated and the therapies applied play critical roles in patient outcomes.
Objectives: This study aimed to evaluate the risk of sustained life-threatening ventricular tachyarrhythmias (VTAs) after hospitalization for heart failure (HHF).
Background: HHF is common among patients with an implantable cardioverter-defibrillator (ICD).
Methods: We analyzed all 5,511 ICD patients enrolled in the landmark MADIT (Multicenter Automatic Defibrillator Implantation Trial) and RAID (Ranolazine in High-Risk Patients With Implanted Cardioverter-Defibrillator) trials.