Mortality, appropriate and inappropriate shocks - observations from an institutional implantable cardioverter defibrillator registry

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Implantable cardioverter defibrillator (ICD) is an effective therapy for primary (PP) and secondary prevention (SP) of sudden cardiac death (SCD). ICD adverse events include inappropriate shocks (IS), device infection and failure. Methods We analysed the data concerning all newly implanted ICDs in our institution from 2011 to 2017. Follow-up data was collected until the end of 2019. Results In total, 507 ICDs were implanted (85.4% male, 57.6 ± 14.0 years-old), 375 (74.0%) for PP and 132 (26.0%) for SP. The mean follow-up was 34.3 ± 23.8 months. ICD delivered therapy in 42.4% of SP and in 28.8% of PP patients (p = 0.15). In PP, shocks were delivered in 25.7% of non-ischaemic heart disease (NIHD) and in 17.6% ischaemic heart disease (IHD) patients (p = 0.81). IS were significantly more common in NIHD patients (13.8% vs 2.4% in IHD group, p < 0.0001). PP patients with NIHD also had a higher shock burden (average of 8.0 ± 17.4 shocks compared to 2.7 ± 3.0 in the IHD group). However, it failed to reach the level of statistical significance (p = 0.052). In SP, the rate of ICD activation and that of IS were similar in both groups (IHD and NIHD). In total, 32.6% of SP patients received appropriate shock (AS) and 5.3% of them received at least one IS (average number of AS and IS being 8.7 ± 11.5 and 1.1 ± 0.4 respectively). Mortality was significantly higher in SP than in PP (34.8% vs 13.9%, p < 0.001). In PP, significantly more deaths occurred among IHD than NIHD patients (18.8% vs 10.0%, p < 0.001). Conclusion The prevalence of AS and IS was relatively higher than reported elsewhere. Same was true for mortality. Interestingly, the rate of IS was somewhat higher in NIHD than in IHD, which was unexpected. ICD outcomes Primary prevention Secondary prevention Total IHD NIHD Total IHD NIHD Patients, n 375 165 210 132 88 44 Patients with ICD activation, n (%) 108 (28.8) 46 (27.9) 62 (29.5) 56 (42.4) 33 (37.5) 22 (50.0) Patientns with AS, n (%) 60 (16.0) 27 (16.4) 33 (15.7) 43 (32.6) 29 (33.0) 14 (31.8) Patientns with IS, n (%) 33 (8.8) 4 (2.4) 29 (13.8) 7 (5.3) 5 (5.7) 2 (4.5) AS delivered (mean ± SD) 5.6 ± 13.3 2.7 ± 3.0 8.0 ± 17.4 8.7 ± 11.5 9.9 ± 12.2 9.7 ± 17.6 IS delivered (mean ± SD) 3.2 ± 5.1 1.2 ± 0.5 3.5 ± 5.4 1.1 ± 0.4 1.0 ± 0 3.2 ± 5.2 Deaths, n (%) 52 (13.9) 31 (18.8) 21 (10.0) 46 (34.8) 32 (36.4) 14 (31.8) Time to death (months, mean ± SD) 20.3 ± 13.9 19.9 ± 12.6 21.1 ± 16.5 27.1 ± 25.7 28.9 ± 24.9 22.6 ± 28.1 ICD, implantable cardioverter defibrillator; IHD, ischemic heart disease; NIHD, non-ischemic heart disease; AS, appropriate shock; IS, inappropriate shock

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Long-term follow-up of Chagas heart disease patients receiving an implantable cardioverter-defibrillator for secondary prevention

Pacing and Clinical Electrophysiology ◽

10.1111/pace.13333 ◽

2018 ◽

Vol 41 (6) ◽

pp. 583-588 ◽

Cited By ~ 2

Author(s):

Maria Licia Ribeiro Cury Pavão ◽

Elerson Arfelli ◽

Adilson Scorzoni-Filho ◽

Anis Rassi ◽

Antônio Pazin-Filho ◽

...

Keyword(s):

Heart Disease ◽

Secondary Prevention ◽

Implantable Cardioverter Defibrillator ◽

Cardioverter Defibrillator ◽

Long Term Follow Up ◽

Chagas Heart Disease

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Should Microvolt T-Wave Alternans Be Utilized Routinely in Selecting Patients for Prophylactic Implantable Cardioverter-Defibrillator Insertion in the Setting of Ischemic Heart Disease?⁎⁎Editorials published in the Journal of the American College of Cardiologyreflect the views of the authors and do not necessarily represent the views of JACCor the American College of Cardiology.

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2006.10.008 ◽

2007 ◽

Vol 49 (1) ◽

pp. 59-61 ◽

Cited By ~ 4

Author(s):

Andrea M. Russo ◽

Francis E. Marchlinski

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Implantable Cardioverter Defibrillator ◽

Ischemic Heart ◽

Cardioverter Defibrillator ◽

T Wave ◽

T Wave Alternans

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PREDICTION OF NON-BENEFIT FROM IMPLANTABLE CARDIOVERTER DEFIBRILLATOR TREATMENT IN PRIMARY PREVENTION PATIENTS WITH ISCHEMIC HEART DISEASE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(11)60140-x ◽

2011 ◽

Vol 57 (14) ◽

pp. E140

Author(s):

Johannes B. Van Rees ◽

C. Jan Willem Borleffs ◽

Guido H. van Welsenes ◽

Enno T. van der Velde ◽

Lieselot van Erven ◽

...

Keyword(s):

Heart Disease ◽

Primary Prevention ◽

Ischemic Heart Disease ◽

Implantable Cardioverter Defibrillator ◽

Ischemic Heart ◽

Cardioverter Defibrillator

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Abstract 16496: Longitudinal Outcomes After Implantation of a Subcutaneous or Transvenous Implantable Cardioverter Defibrillator in Older Patients: A Report From the National Cardiovascular Data Registry

Circulation ◽

10.1161/circ.142.suppl_3.16496 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Daniel J Friedman ◽

Craig Parzynski ◽

E. Kevin Heist ◽

Andrea M Russo ◽

Isuru Ranasinghe ◽

...

Keyword(s):

Heart Disease ◽

Ischemic Heart Disease ◽

Implantable Cardioverter Defibrillator ◽

Older Patients ◽

Cox Regression ◽

Ischemic Heart ◽

Cardioverter Defibrillator ◽

Data Registry ◽

All Cause Mortality ◽

National Cardiovascular

Introduction: The subcutaneous (S-) implantable cardioverter defibrillator (ICD) is an alternative to the transvenous (TV-) ICD that is increasingly implanted in younger patients. However, data on the safety and effectiveness of the S-ICD in older patients are lacking. Methods: We compared S-ICD and single chamber TV-ICD implants in Medicare beneficiaries (≥65yrs) using National Cardiovascular Data Registry ICD Registry data from 9/28/2012 through 12/31/2017. We excluded patients with prior pacemaker or ICD, an indication for pacing or resynchronization, and those undergoing implant in an acute setting. Mortality status was determined using the Medicare master summary beneficiary file. Cox regression analyses with overlap weights were used to compare all-cause mortality. Mean cumulative counts of all-cause readmissions were compared among for Fee for Service beneficiaries. Results: A total of 23,717 patients met inclusion criteria [mean age 72.7±5.8 years, 29% female, 69% ischemic heart disease, 33% atrial arrhythmias, 49% NYHA II, 31.7% NYHA III, ejection fraction (EF) 28±9%, 3% dialysis dependent, 20% with prior ventricular tachycardia]. Compared to TV-ICD patients (n=22,264), S-ICD patients (n=1,453, 6% overall) were more often male, black, diabetic, dialysis dependent and were less likely to have atrial or ventricular arrhythmias or ischemic heart disease. There was no difference in age or EF between the 2 groups. In adjusted analyses, during a median follow-up of 2.3 years (IQR: 1.2 - 3.5), there was no difference between the 2 groups in all-cause mortality (HR 1.04, CI 0.91-1.17, Figure A ) or readmissions (based on overlap of confidence intervals, Figure B ). Conclusions: In a large representative cohort of older patients undergoing ICD implant, all-cause mortality and readmission were similar among S-ICD and TV-ICD recipients. These findings support use of the S-ICD for the prevention of sudden cardiac death in appropriately selected older patients.

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Long-Term Follow-Up of Implantable Cardioverter-Defibrillator for Secondary Prevention in Chagas' Heart Disease

The American Journal of Cardiology ◽

10.1016/j.amjcard.2012.05.040 ◽

2012 ◽

Vol 110 (7) ◽

pp. 1040-1045 ◽

Cited By ~ 25

Author(s):

Martino Martinelli ◽

Sérgio Freitas de Siqueira ◽

Eduardo Back Sternick ◽

Anis Rassi ◽

Roberto Costa ◽

...

Keyword(s):

Heart Disease ◽

Secondary Prevention ◽

Implantable Cardioverter Defibrillator ◽

Cardioverter Defibrillator ◽

Long Term Follow Up ◽

Chagas Heart Disease

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Cerebral embolism and complex aortic plaques: Secondary prevention

Stroke ◽

10.1161/str.32.suppl_1.378-a ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 378-378

Author(s):

Robert Wetterholm ◽

Christian Blomstrand ◽

Elisabeth Aspenlid ◽

Odd Bech-Hansen ◽

Kenneth Caidahl

Keyword(s):

Heart Disease ◽

Secondary Prevention ◽

Ischemic Heart Disease ◽

Oral Anticoagulation ◽

Cerebral Embolism ◽

Ischemic Heart ◽

Embolic Event ◽

Significant Difference ◽

Group A

P212 Background: After a cerebral embolic event, complex plaques in the proximal aorta constitute an important finding by transesophageal echocardiography (TEE). Yet, there is no consensus regarding its optimal treatment, and we studied the short-term outcome in this group of patients. Method: Between August 1995 and August 1998, 424 patients were examined with TEE after a suspected cerebral embolic event. We re-evaluated the 94 examinations with any plaques noticed in the proximal aorta and reviewed the medical charts for previous embolic events, diabetes, hypertension, ischemic heart disease, ECG, laboratory findings, antithrombotic treatment and outcome (mean follow-up time 19 months). Results: Of 94 patients with any plaques in the proximal aorta, 75 were complex (protruded more than 4 mm or had a mobile component), and 55 of these were finally diagnosed as having suffered cerebral embolism. After exclusion of 8 patients with atrial fibrillation, 47 patients constituted the study group. As secondary prevention, 32 and 15 patients were on antiplatelets and oral anticoagulation, respectively, at event or end of follow-up. In the antiplatelet group (A), 8 of 32 patients (25%) suffered a new cerebral embolic episode vs. none in the anticoagulant group (B) (p=0.03). Mean time to recurrent embolism was 10 months. No hemorrhagic stroke or other important bleeding occurred during follow-up. Leukocyte count was slightly higher in group A (8.7±2.4 vs. 7.2 ± 1.9× 10 9 /L, p=0.04), no other significant difference was found between groups A and B regarding mean age (64 vs. 67 years), systolic blood pressure (171±32 vs. 166±23mmHg, p=0.60), left atrial size (17.9±4.0 vs. 19.0±5.0 cm 2 , p=0.42), hemoglobin conc. (143±15 vs. 140±14 g/L, p=0.53), S-cholesterol (5.9±1.5 vs. 6.5±1.2 mmol/L, p=0.23), S-triglycerides (1.9±1.0 vs. 2.0±1.1 mmol/L, p=0.70), history of diabetes, ischemic heart disease, hypertension or smoking. Conclusion: Complex plaques in the proximal aorta are frequently found in patients with cerebral embolism. Our study indicates that these patients benefit from oral anticoagulation, while treatment with antiplatelets is associated with a high incidence of recurrent embolism.

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