Performance of the subcutaneous implantable cardioverter-defibrillator in patients with a primary prevention indication with and without a reduced ejection fraction versus patients with a secondary prevention indication

Abstract Background Patients with an implantable cardioverter defibrillator (ICD) are restricted from driving following initial implantation or ICD shock. It is unclear how many patients are aware of, and adhere to, these restrictions. Purpose To investigate knowledge of, and adherence to, private and professional driving restrictions in a nationwide cohort of ICD patients. Methods A questionnaire was distributed to all living Danish residents ≥18 years who received a first-time ICD between 2013 and 2016 (n=3,913). During this period, Danish guidelines recommended 1 week driving restriction following ICD implantation for primary prevention, and 3 months following either ICD implantation for secondary prevention or appropriate ICD shock, and permanent restriction of professional driving and driving of large vehicles (>3.5 metric tons). Questionnaires were linked with relevant nationwide registries. Logistic regression was applied to identify factors associated with non-adherence. Results Of 2,741 questionnaire respondents, 92% (n=2,513) held a valid private driver's license at time of ICD implantation (85% male; 46% primary prevention indication; median age: 67 years (IQR: 59–73)). Of these, 7% (n=175) were actively using a professional driver's license for truck driving (n=73), bus driving (n=45), taxi driving (n=22), large vehicle driving for private use (n=54), or other purposes (n=32) (multiple purposes allowed). Only 42% of primary prevention patients, 63% of secondary prevention patients, and 72% of patients who experienced an appropriate ICD shock, recalled being informed of any driving restrictions. Only 45% of professional drivers recalled being informed about specific professional driving restrictions (Figure). Most patients (93%, n=2,344) resumed private driving after ICD implantation, more than 30% during the driving restriction period: 34% of primary prevention patients resumed driving within 1 week, 43% of secondary prevention patients resumed driving within 3 months, and 30% of patients who experienced an appropriate ICD shock resumed driving within 3 months. Professional driving was resumed by 35%. Patients who resumed driving within the restricted periods were less likely to report having received information about driving restrictions (all p<0.001) (Figure). In a multiple logistic regression model, non-adherence was predicted by reporting non-receipt of information about driving restrictions (OR: 3.34, CI: 2.27–4.03), as well as male sex (OR: 1.53, CI: 1.17–2.01), age ≥60 years (OR: 1.20, CI: 1.02–1.64), receipt of a secondary prevention ICD (OR: 2.2, CI: 1.80–2.62), and being the only driver in the household (OR: 1.29, CI: 1.05–1.57). Conclusion In this nationwide survey study, many ICD patients were unaware of the driving restrictions, and many ICD patients, including professional drivers, resumed driving within the restricted periods. More focus on communicating driving restrictions might improve adherence. Acknowledgement/Funding Danish Heart Foundation, Arvid Nilsson Foundation, Fraenkels Mindefond

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THE ROLE OF BASELINE VERSUS LONG-TERM FOLLOW-UP EJECTION FRACTION IN PREDICTING ADVERSE EVENTS AMONG PRIMARY PREVENTION IMPLANTABLE CARDIOVERTER DEFIBRILLATOR RECIPIENTS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(17)34130-x ◽

2017 ◽

Vol 69 (11) ◽

pp. 741 ◽

Cited By ~ 1

Author(s):

Daniel J. Friedman ◽

Robert Overton ◽

Linda Shaw ◽

Marat Fudim ◽

Divyang Patel ◽

...

Keyword(s):

Primary Prevention ◽

Adverse Events ◽

Ejection Fraction ◽

Implantable Cardioverter Defibrillator ◽

Cardioverter Defibrillator ◽

Long Term Follow Up

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Implantable cardioverter-defibrillator implantation for primary and secondary prevention: indications and outcomes

Cardiology in the Young ◽

10.1017/s1047951116002365 ◽

2017 ◽

Vol 27 (S1) ◽

pp. S126-S131 ◽

Cited By ~ 3

Author(s):

Justin M. Pick ◽

Anjan S. Batra

Keyword(s):

Primary Prevention ◽

High Risk ◽

Sudden Cardiac Death ◽

Secondary Prevention ◽

Implantable Cardioverter Defibrillator ◽

Cardiac Death ◽

Implantable Cardioverter Defibrillators ◽

Cardioverter Defibrillator ◽

Device Implantation ◽

Risk Event

AbstractImplantable cardioverter-defibrillators effectively reduce the rate of sudden cardiac death in children. Significant efforts have been made to better characterise the indications for their placement, and over the past two decades there has been a shift in their use from secondary to primary prevention. Primary prevention includes placement in patients thought to be at high risk of sudden cardiac death before the patient experiences any event. Secondary prevention includes placement after a high-risk event including sustained ventricular tachycardia or resuscitated cardiac arrest. Although liberal device implantation may be appealing even in patients having marginal indications, studies have shown high rates of adverse effects including inappropriate device discharges and the need for re-intervention because of hardware malfunction. The indications for placement of an implantable cardioverter-defibrillator, whether for primary or secondary prevention of sudden cardiac death, vary based on cardiac pathology. This review will assist the provider in understanding the risks and benefits of device implantation in order to enhance the shared decision-making capacity of patients, families, and providers.

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The Effect of Sacubitril/Valsartan on Device Detected Arrhythmias and Electrical Parameters among Dilated Cardiomyopathy Patients with Reduced Ejection Fraction and Implantable Cardioverter Defibrillator

Journal of Clinical Medicine ◽

10.3390/jcm9041111 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1111 ◽

Cited By ~ 1

Author(s):

Vincenzo Russo ◽

Roberta Bottino ◽

Anna Rago ◽

Andrea Antonio Papa ◽

Biagio Liccardo ◽

...

Keyword(s):

Ejection Fraction ◽

Dilated Cardiomyopathy ◽

Implantable Cardioverter Defibrillator ◽

Reverse Remodeling ◽

Electrical Parameters ◽

Pacing Threshold ◽

Reduced Ejection Fraction ◽

Cardioverter Defibrillator ◽

Echocardiographic Parameters

Sacubitril/valsartan therapy reduces sudden cardiac death (SCD) among patients with reduced ejection fraction (HFrEF) when compared to guidelines recommended doses of enalapril, however the mechanism is still not clear. There are few, contrasting results about the effect of sacubitril/valsartan on arrhythmias in the clinical context of dilated cardiomyopathy (DCM) and there are no clinical data about its effect on measured implantable cardioverter defibrillator (ICD) electrical parameters, such as atrial/ventricular electrograms sensing and pacing threshold. We conducted a 12 month follow-up observational study in 167 ischemic and nonischemic DCM patients (mean age 68.1 ± 11.6 years; 85% male), with dual-chamber ICD on sacubitril/valsartan treatment, to evaluate the incidence of device detected tachyarrhythmia events, both atrial and ventricular, and the change in measured ICD electrical parameters. We collected data on clinical, electrocardiographic and echocardiographic parameters to find a possible electro-mechanical correlation within results. Our results show that DCM patients with reduced ejection fraction and ICD on sacubitril/valsartan treatment experienced a reduction in both atrial and ventricular arrhythmias incidence and an improvement in ICD electrical atrial parameters. The findings might be explained by the electro-mechanical cardiac reverse remodeling induced by sacubitril/valsartan therapy.

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