Actual conditions of implantable defibrillation therapy over 5 years in Japan

Abstract

a b s t r a c tPurpose: The aim of this study was to describe the recent conditions associated with implantable defibrillation therapy for individual underlying heart diseases. Methods: Ten thousand six hundred and five patients with implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy defibrillators (CRT-Ds) that were implanted from 2006 to 2010 were selected from the Japan Cardiac Device Therapy Registry database. They were divided into 12 disease categories and further divided into either primary or secondary prevention of sudden cardiac death. Results: The major underlying diseases of the patients in this cohort were ischemic heart disease (IHD, 35%), dilated cardiomyopathy (DCM, 25%), hypertrophic cardiomyopathy (HCM, 8%), and Brugada syndrome (Brugada, 8%). There were no structural heart diseases in this cohort; the incidence of IHD was relatively lower than that of western countries, while the incidence of cardiomyopathy was higher. The percentage of primary prevention (% primary) among the individual diseases varied. IHD was the most prevalent underlying condition in the patient cohort; however, the % primary was 33%, which was relatively lower than that of the other structural heart diseases. The % primary was relatively higher in patients with DCM (57%) and Brugada (47%). Over 5 years, the % primary gradually increased in patients with DCM, IHD, and HCM, with a particularly dramatic increase in those with DCM. A decrease in the % primary among patients with Brugada began in 2008. Conclusions: In patients that underwent implantable defibrillation therapy, there was a relatively lower % primary in the IHD group, and a substantial increase in the % primary in patients with DCM.

Prognostic significance of nonsustained ventricular tachycardia in patients receiving cardiac resynchronization therapy for primary prevention: Analysis of the Japan cardiac device treatment registry database

“…The JCDTR was established in 2006 by the Japanese Heart Rhythm Society (JHRS) for a survey of actual conditions in patients undergoing implantation of cardiac implantable electronic devices (ICD/CRT‐D/CRT‐P) as described previously . Members of the JHRS are encouraged to register their data under a unified protocol, which was normally approved by each facility.…”

“…The JCDTR was established in 2006 by the Japanese Heart Rhythm Society (JHRS) for a survey of actual conditions in patients undergoing implantation of cardiac implantable electronic devices (ICD/CRT-D/ CRT-P) as described previously. [5][6][7] Members of the JHRS are encouraged to register their data under a unified protocol, which was normally approved by each facility. The protocol for this research project has been approved by a suitably constituted Ethics Committee of the institution and it conforms to the provisions of the Declaration of Helsinki.…”

Comparison of ICD shock rates in Japanese and non‐Japanese patients in the PainFree SST study

“…Nevertheless, this clinical study was conducted mainly in Western countries and did not thoroughly reflect the patient background of the population from eastern Asia including Japan. It is known that patient baseline characteristics are different between Western countries and Japan . However, it is unknown if these differences lead to different outcomes including the occurrence of inappropriate shocks.…”

Japan Implantable Devices in Coronary Artery Disease (JID‐CAD) study design

“…ICDs were first approved by the Japanese government more than 20 years ago; they are widely used, and are considered the most effective therapy for lethal ventricular tachyarrhythmia, both in Japan and globally. The Japan Cardiac Device Treatment Registry (JCDTR), run by the Japanese Heart Rhythm Society (JHRS), founded in 2006, records the current clinical situation of cardiac implantable defibrillator devices [4,5].…”

“…The rate of CAD in Japanese patients implanted with ICDs is lower than in Western countries; the percentage of devices implanted for primary prevention is also markedly lower [4,11,12]. The prognosis of Japanese patients with CAD was hypothesized to improve following application of MADIT‐II criteria [1,13–15]; however, some investigators have suggested that application of MADIT‐II criteria to Japanese patients may be inappropriate [13].…”