Combined Plasma Levels of A-type-Natriuretic Peptide And Adrenomedullin Are Associated With Appropriate Anti-Arrhythmia Therapy in Patients With an Implantable Cardioverter Defibrillator but no prior Device Therapy

Background Identifying patients benefiting from implantable cardioverter defibrillators (ICD) especially when replacing one that has never served may be challenging. Objectives We assessed the association between plasma levels of mid-regional-pro-A-type-natriuretic peptide (ANP), Mid-regional-pro-adrenomedullin (ADM) and aldosterone and, appropriate Implantable Cardioverter Defibrillator (ICD)-therapy in patients with an ICD but no prior therapy. Methods A cohort of 331 consecutive patients with an ICD but no prior ICD-therapy was prospectively included in 2 centers and followed-up for a median of 7.9 years. Plasma aldosterone, ANP and ADM levels were measured at inclusion. The primary outcome was the occurrence of appropriate ICD-therapy. Results Appropriate ICD-therapy and death occurred in 106(32%) and 114(34%) patients respectively. Rates of ICD generator replacement were 62% regardless of ICD-therapy. The multivariable model showed significant relationships between ANP > median (adjusted HR 1.73[95% CI 1.04-2.86]) and ADM > median (HR 0.53 [95% CI 0.32-0.89]) but not aldosterone, and ICD-therapy. The Fine and Gray analysis accounting mortality as a competing risk showed similar results. Conclusions The combination of ANP and ADM are independently associated with the risk of ICD-therapy in patients with an ICD that has never served, and may participate in stratifying patients who may benefit most from ICD generator replacement.