One size fits all, or do we have to rethink optimal programming in implantable cardioverter-defibrillators implanted for secondary prevention?

Abstract Background In the Polish ICD Registry population secondary prevention recipients account for over 27%. Despite the evolution of indications for secondary prevention implantable cardioverter defibrillators (ICDs), recommendations regarding the use of ICDs for secondary prevention of sudden cardiac death (SCD) rely on information from a small number of randomized controlled trials that were performed decades ago, with mixed results. Moreover, research on the outcomes after implantations for secondary prevention of ICDs is limited. While dual-chamber devices offer theoretical advantage over single-chamber devices, dual-chamber ICDs (DC-ICDs) were announced not superior to single-chamber (SC-ICDs) in some research. Purpose Therefore, the aim of the study was to evaluate the all-cause mortality among patients from the Polish ICD Registry receiving either a single- or a dual-chamber device for secondary prevention in contemporary clinical practice. Methods All patients enrolled in the Polish ICD Registry from 1995 to 2016 were identified. Patients were included in the study if they were designated as receiving an ICD for secondary prevention of SCD after documented tachycardic arrest, sustained ventricular tachycardia (VT), or syncope. Kaplan-Meier survival analysis was used to assess all-cause mortality. Results In the study population of 3596 ICD recipients (mean age 69±12 years, 81% male, SC-ICD 61%, DC-ICD 39%), during mean follow-up of 79±43 months all-cause mortality rate was higher in the dual-chamber group than in the single chamber group, with a significant difference between the two groups as depicted in Kaplan-Meier curve (p<0,05). The median survival time was 98 months versus 110 months for SC and DC-ICD, respectively. Conclusions This study is the first to describe the characteristics of a national cohort of patients receiving a secondary prevention ICD in such a long follow-up period in contemporary practice. Implantation of a dual-chamber ICD was associated with higher all-cause mortality compared with single chamber devices.

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Outcomes Among Older Patients Receiving Implantable Cardioverter-Defibrillators for Secondary Prevention

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2016.10.062 ◽

2017 ◽

Vol 69 (3) ◽

pp. 265-274 ◽

Cited By ~ 11

Author(s):

Jarrod K. Betz ◽

David F. Katz ◽

Pamela N. Peterson ◽

Ryan T. Borne ◽

Sana M. Al-Khatib ◽

...

Keyword(s):

Secondary Prevention ◽

Older Patients ◽

Implantable Cardioverter Defibrillators ◽

Cardioverter Defibrillators

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Better Than You Think—Appropriate Use of Implantable Cardioverter-Defibrillators at a Single Academic Center: A Retrospective Review

Cardiovascular Innovations and Applications ◽

10.15212/cvia.2021.0005 ◽

2021 ◽

Author(s):

Nikhil Shah

Keyword(s):

Secondary Prevention ◽

Evidence Based ◽

Implantable Cardioverter Defibrillators ◽

Appropriate Use ◽

Icd Implantation ◽

Individualized Care ◽

Academic Center ◽

Life Saving ◽

The Difference ◽

Cardioverter Defibrillators

Background: Implantable cardioverter-defibrillators (ICDs) can be life-saving devices, although they are expensiveand may cause complications. In 2013, several professional societies published joint appropriate use criteria (AUC)assessing indications for ICD implantation. Data evaluating the clinical application of AUC are limited. Previous registry-based studies estimated that 22.5% of primary prevention ICD implantations were “non-evidence-based” implantations. On the basis of AUC, we aimed to determine the prevalence of “rarely appropriate” ICD implantation at our institution for comparison with previous estimates.Methods: We reviewed 286 patients who underwent ICD implantation between 2013 and 2016. Appropriateness of each ICD implantation was assessed by independent review and rated on the basis of AUC.Results: Of 286 ICD implantations, two independent reviewers found that 89.5% and 89.2%, respectively, were appropriate,5.6% and 7.3% may be appropriate, and 1.8% and 2.1% were rarely appropriate. No AUC indication was found for 3.5% and 3.4% of ICD implantations, respectively. Secondary prevention ICD implantations were more likely rarely appropriate (2.6% vs. 1.2% and 3.6% vs. 1.1%) or unrated (6.0% vs. 1.2% and 2.7% vs. 0.6%). The reviewers found 3.5% and 3.4% of ICD implantations, respectively, were non-evidence-based implantations. The difference in rates between reviewers was not statistically significant.Conclusion: Compared with prior reports, our prevalence of rarely appropriate ICD implantation was very low. Thehigh appropriate use rate could be explained by the fact that AUC are based on current clinical practice. The AUC couldbenefit from additional secondary prevention indications. Most importantly, clinical judgement and individualized care should determine which patients receive ICDs irrespective of guidelines or criteria.

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