Frequency and Causes of Implantable Cardioverter-Defibrillator Therapies: Is Device Therapy Proarrhythmic?

Germano, Joseph; Reynolds, Matthew R.; Essebag, Vidal; Josephson, Mark E.

doi:10.1016/j.amjcard.2005.11.048

Cited by 201 publications

(166 citation statements)

References 46 publications

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“…This result is consistent with the reports of other investigators who have also found that the number of AICDTs greatly exceeds the ICD mediated reduction in deaths in clinical ICD trials 16,17 . One explanation for the excess number of AICDTs is that ICDs treat arrhythmias that would have self-terminated had no ICD been implanted.…”

Section: Discussion Predictive Accuracy Of Mtwasupporting

confidence: 93%

“…One explanation for the excess number of AICDTs is that ICDs treat arrhythmias that would have self-terminated had no ICD been implanted. Another possible explanation is that ICDs are themselves arrhythmogenic and induce arrhythmias that they then end up treating 17 . Whatever the mechanism, the large excess of the number of patients receiving AICDT over the number of patients averting SCD indicates that AICDT is an unreliable surrogate for a SCD endpoint in clinical trials 18 .…”

Section: Discussion Predictive Accuracy Of Mtwamentioning

confidence: 99%

“…ICD therapy is associated with its own morbidity and mortality including infection, lead breakage, inappropriate shocks, perforation, device and lead recalls 17 . The early complication rate associated with just the ICD implantation procedure itself has been reported to be 11%…”

Section: Benefit Of Icd Therapy In Mtwa Non-negative Versus Negative mentioning

confidence: 99%

“…Recent analyses of ICD trials 16,17 have concluded that AICDTs in the ICD arms of the studies exceeded sudden deaths in the control arms by a factor of two to three. These analyses raise questions about the suitability of AICDT as a surrogate endpoint for SCD in clinical trials 18 .…”

Section: Introductionmentioning

confidence: 99%

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Evidence regarding clinical use of microvolt T-wave alternans

2009

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Section: Discussion Predictive Accuracy Of Mtwasupporting

confidence: 93%

Section: Discussion Predictive Accuracy Of Mtwamentioning

confidence: 99%

Section: Benefit Of Icd Therapy In Mtwa Non-negative Versus Negative mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Evidence regarding clinical use of microvolt T-wave alternans

2009

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“…Further, inappropriate shocks may be proarrhythmic and are associated with higher mortality 6, 7, 8. The most common cause for inappropriate shocks is supraventricular tachycardia incorrectly identified by the device as a lethal ventricular tachyarrhythmia 9.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Inappropriate Shocks and Other Health Outcomes Between Single‐ and Dual‐Chamber Implantable Cardioverter‐Defibrillators for Primary Prevention of Sudden Cardiac Death: Results From the Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter‐Defibrillators

Peterson

Greenlee

et al. 2017

JAHA

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BackgroundIn US clinical practice, many patients who undergo placement of an implantable cardioverter‐defibrillator (ICD) for primary prevention of sudden cardiac death receive dual‐chamber devices. The superiority of dual‐chamber over single‐chamber devices in reducing the risk of inappropriate ICD shocks in clinical practice has not been established. The objective of this study was to compare risk of adverse outcomes, including inappropriate shocks, between single‐ and dual‐chamber ICDs for primary prevention.Methods and ResultsWe identified patients receiving a single‐ or dual‐chamber ICD for primary prevention who did not have an indication for pacing from 15 hospitals within 7 integrated health delivery systems in the Longitudinal Study of Implantable Cardioverter‐Defibrillators from 2006 to 2009. The primary outcome was time to first inappropriate shock. ICD shocks were adjudicated for appropriateness. Other outcomes included all‐cause hospitalization, heart failure hospitalization, and death. Patient, clinician, and hospital‐level factors were accounted for using propensity score weighting methods. Among 1042 patients without pacing indications, 54.0% (n=563) received a single‐chamber device and 46.0% (n=479) received a dual‐chamber device. In a propensity‐weighted analysis, device type was not significantly associated with inappropriate shock (hazard ratio, 0.91; 95% confidence interval, 0.59–1.38 [P=0.65]), all‐cause hospitalization (hazard ratio, 1.03; 95% confidence interval, 0.87–1.21 [P=0.76]), heart failure hospitalization (hazard ratio, 0.93; 95% confidence interval, 0.72–1.21 [P=0.59]), or death (hazard ratio, 1.19; 95% confidence interval, 0.93–1.53 [P=0.17]).ConclusionsAmong patients who received an ICD for primary prevention without indications for pacing, dual‐chamber devices were not associated with lower risk of inappropriate shock or differences in hospitalization or death compared with single‐chamber devices. This study does not justify the use of dual‐chamber devices to minimize inappropriate shocks.

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A 59-Year-Old Man Considering Implantation of a Cardiac Defibrillator

Zimetbaum¹

2007

JAMA

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Nearly 450,000 individuals experience sudden cardiac death yearly in the United States. A history of prior myocardial infarction with resultant left ventricular dysfunction identifies a group at particularly high risk of sudden arrhythmic death. Implantable cardioverter-defibrillators have proven highly effective at reducing this risk and are now increasingly implanted in patients with this risk profile. The case of Mr M, a 59-year-old man with a history of myocardial infarction, low ejection fraction, and mild congestive heart failure, who is considering implantable cardioverter-defibrillator placement, illustrates the issues in having a device implanted as a prophylactic measure as well as increasing concerns due to device recalls and malfunction. A thorough discussion of the benefits and risks associated with this therapy is necessary for patients and physicians to make appropriate decisions with regard to the primary prevention of sudden death.

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Frequency and Causes of Implantable Cardioverter-Defibrillator Therapies: Is Device Therapy Proarrhythmic?

Cited by 201 publications

References 46 publications

Evidence regarding clinical use of microvolt T-wave alternans

Evidence regarding clinical use of microvolt T-wave alternans

Comparison of Inappropriate Shocks and Other Health Outcomes Between Single‐ and Dual‐Chamber Implantable Cardioverter‐Defibrillators for Primary Prevention of Sudden Cardiac Death: Results From the Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter‐Defibrillators

A 59-Year-Old Man Considering Implantation of a Cardiac Defibrillator

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