Algorithm predicts patients best suited for getting ICDs

Researcher have developed a prediction tool that identifies patients with a rare heart condition most likely to benefit from receiving an implantable defibrillator.

The initiative, by an international team led by Johns Hopkins Medicine, seeks a computational solution to treat, arrhythmogenic right ventricular cardiomyopathy (ARVC), an inherited disease of the lower heart chambers that can cause fatal irregular heartbeats.

Implantable cardioverter-defibrillators (ICDs), which detect electrical abnormalities in heart muscle and immediately shocks the heart to re-establish normal rhythm, can prevent sudden cardiac death and save lives. However, ICDs have risks and side effects.

“If someone is at risk of sudden cardiac death, you don't want to miss the chance of putting in a lifesaving device. But you also don't want to put it in if that risk is not worth taking,” says Hugh Calkins, MD, professor of cardiology at the Johns Hopkins University School of Medicine and director of the Electrophysiology Laboratory and Arrhythmia Service at The Johns Hopkins Hospital. “This new model can help doctors and patients decide better if an ICD is warranted on a case-by-case basis.”

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Results of a study, published Wednesday in the European Heart Journal, show that the model accurately accounted for which patients would have life-threatening events and—when researchers compared their prediction accuracy rates with outcomes using a current consensus-based ICD placement algorithm—about 20 percent of recommended ICD placements would have likely been unnecessary.

“Using the largest cohort of patients with ARVC and no prior ventricular arrhythmias, a prediction model using readily available clinical parameters was devised to estimate VA risk and guide decisions regarding primary prevention ICDs,” states the study’s authors. “This model, based on readily available clinical parameters, performs better than the current consensus guideline and has the potential to set the standard for prophylactic ICD placement in ARVC.”

Based on their work, researchers have made a free app available—the ARVC Risk Calculator—that rapidly inputs medical data to calculate to generate individualized estimates of the risk of ventricular arrhythmias.

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