Journal article
Incidence of and predictors for appropriate implantable cardioverter-defibrillator therapy in patients with a secondary preventive implantable cardioverter-defibrillator indication.
- Schaer B Department of Cardiology, University Hospital of Basel, Petersgraben 4, Basel 4031, Switzerland bschaer@uhbs.ch.
- Kühne M Department of Cardiology, University Hospital of Basel, Petersgraben 4, Basel 4031, Switzerland.
- Reichlin T Department of Cardiology, University Hospital of Basel, Petersgraben 4, Basel 4031, Switzerland.
- Osswald S Department of Cardiology, University Hospital of Basel, Petersgraben 4, Basel 4031, Switzerland.
- Sticherling C Department of Cardiology, University Hospital of Basel, Petersgraben 4, Basel 4031, Switzerland.
- 2015-06-12
Published in:
- Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - 2016
Cumulative incidence
Implantable cardioverter-defibrillator
Predictor
Secondary prevention
Aged
Cardiomyopathy, Dilated
Death, Sudden, Cardiac
Electric Countershock
Female
Humans
Incidence
Kaplan-Meier Estimate
Male
Middle Aged
Proportional Hazards Models
Registries
Retrospective Studies
Risk Factors
Secondary Prevention
Tachycardia, Ventricular
Time Factors
Treatment Outcome
Ventricular Fibrillation
English
AIMS
Incidence of implantable cardioverter-defibrillator (ICD) therapy in secondary prevention has been assessed in randomized trials and registries. However, results are considerably limited by short follow-up and hazy definition of treated arrhythmias. This study aimed to determine appropriate ICD therapy and to define predictors based on registry patients followed for up to 20 years.
METHODS AND RESULTS
All patients with a secondary prevention indication and ischaemic or dilated cardiomyopathy were identified. Arrhythmic endpoints were appropriate ICD therapies for any ventricular tachycardia (VT) >175 b.p.m. and appropriate ICD therapies in the ventricular fibrillation (VF) zone of >220 b.p.m. (potentially life-threatening). Predictors were determined by analysing 19 baseline characteristics. We included 357 patients, age 65 ± 11 years, predominantly male (89%) with ischaemic cardiomyopathy (83%). During follow-up of 82 ± 53 months, 156 (44%) patients died and 208 received any form of ICD therapies (59%), 71 of them (34%) in the VF zone. Forty-four patients (28%) died without experiencing any form of appropriate ICD therapy. Cumulative incidence of any form of ICD therapy at 10 years was 65%. Predictors for any form of ICD therapy were implantation for VT and age [VT: hazard ratio (HR) 1.45, 95% confidence interval (95% CI) 1.05-2.01, P = 0.03; age (per year): HR 1.02, 95% CI 1.01-1.04, P = 0.001]. For therapy in the VF zone, univariate analysis determined male gender (29 vs. 5%, P = 0.01) as predictor.
CONCLUSION
The rate of appropriate ICD therapies in secondary prevention is high. No useful predictors for them, especially not for life-threatening arrhythmias could be identified.
Incidence of implantable cardioverter-defibrillator (ICD) therapy in secondary prevention has been assessed in randomized trials and registries. However, results are considerably limited by short follow-up and hazy definition of treated arrhythmias. This study aimed to determine appropriate ICD therapy and to define predictors based on registry patients followed for up to 20 years.
METHODS AND RESULTS
All patients with a secondary prevention indication and ischaemic or dilated cardiomyopathy were identified. Arrhythmic endpoints were appropriate ICD therapies for any ventricular tachycardia (VT) >175 b.p.m. and appropriate ICD therapies in the ventricular fibrillation (VF) zone of >220 b.p.m. (potentially life-threatening). Predictors were determined by analysing 19 baseline characteristics. We included 357 patients, age 65 ± 11 years, predominantly male (89%) with ischaemic cardiomyopathy (83%). During follow-up of 82 ± 53 months, 156 (44%) patients died and 208 received any form of ICD therapies (59%), 71 of them (34%) in the VF zone. Forty-four patients (28%) died without experiencing any form of appropriate ICD therapy. Cumulative incidence of any form of ICD therapy at 10 years was 65%. Predictors for any form of ICD therapy were implantation for VT and age [VT: hazard ratio (HR) 1.45, 95% confidence interval (95% CI) 1.05-2.01, P = 0.03; age (per year): HR 1.02, 95% CI 1.01-1.04, P = 0.001]. For therapy in the VF zone, univariate analysis determined male gender (29 vs. 5%, P = 0.01) as predictor.
CONCLUSION
The rate of appropriate ICD therapies in secondary prevention is high. No useful predictors for them, especially not for life-threatening arrhythmias could be identified.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1093/europace/euv188
- PMID 26063686
- Persistent URL
- https://sonar.ch/global/documents/270119
Statistics
Document views: 9
File downloads: