Author + information
- Ahmed Harhasha,b,
- James Cassutoa,b,
- Ahmed Husseina,b,
- Emmanuel Achua,b,
- Marshall Rovnera,b,
- Mark Zuckera,b,
- Marc Goldschmidta,b and
- David Barana,b
Background: Continuous outpatient milrinone infusion is a proposed therapy for patients (pts) with NYHA-IV stage D HF, yet it is associated with an increase in ventricular dysrhythmias. As such, guidelines advise caution using milrinone in pts with a history of ventricular tachycardia (VT). As inotropic therapy improves hemodynamic parameters and decreases myocardial stretch, we hypothesized that despite a known history of sustained ventricular tachycardia VT, milrinone does not increase mortality in stage D HF pts.
Methods: This is a single center retrospective chart review from the ICD clinic, of 98 consecutive pts on continuous milrinone from 2008-2016. The primary endpoint of the study was survival on milrinone, secondary endpoint was appropriate shocks for VT/VF. Pts were separated into two groups – those with documented sustained VT during the 3 month period prior to starting milrinone (n=14) and those without (n=84). Kaplan-Meier survival curves and descriptive analyses were used to compare the outcomes of the two groups.
Results: The mean milrinone dose for pts with prior sustained VT compared to those without was 0.43 vs 0.48 μg/kg/min (P=0.038) and infusion was uninterrupted during the study. There was no difference in survival between pts with prior VT compared to those without at 1 month (92% vs 97%, P=0.340), 6 months (67% vs 73%, P=0.754), and 12 months (67% vs 61%, P=0.888) on milrinone therapy. At 1-3 months f/u after starting milrinone, 40% of pts with VT prior to milrinone received a shock (for sustained VT/VF), compared to 5.1% for those without (P=0.002), at 4-6 months f/u this was 30% vs 8.9% (P=0.104), at 7-9 month f/u this was 16.7% vs 0% (P=0.171), and at 9-12 months f/u this was 50% vs 4.8% (P=0.057).
Conclusions: Following initiation of milrinone therapy, the unadjusted survival between stage D HF pts with history of sustained VT is similar to those without. However, those with documented episodes of sustained VT received statistically significantly (albeit not necessarily clinically significantly) lower doses of milrinone and received more shocks for sustained VT and VF. Milrinone remains a viable alternative therapy for stage D HF pts with limited therapeutic options.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Emerging Developments in HFpEF and Arryhthmias
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1250-290
- 2017 American College of Cardiology Foundation