Normalization of Left Ventricular Ejection Fraction and Incidence of Appropriate Antitachycardia Therapy in Patients With Implantable Cardioverter Defibrillator for Primary Prevention of Sudden Death

House, Chad M.; Nguyen, Danny; Thomas, Avis J.; Nelson, W. Bradley; Zhu, Dennis W

doi:10.1016/j.cardfail.2015.10.015

Cited by 14 publications

(11 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 31,640 patients from 20 studies (14 retrospective and 6 prospective registries) were included in our meta-analysis (Figure 1) with a mean ± standard deviation age of 65.6 ± 4.7 years (mean age range, 57-76 years) and follow-up period of 3.1 ± 1.5 years. 2,6,10,11,[16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] The critical appraisal performed using the Newcastle-Ottawa scale revealed that the quality of studies was good (Table S1).…”

Section: Resultsmentioning

confidence: 99%

Incidence and Predictors of Implantable Cardioverter-defibrillator Therapies After Generator Replacement—A Pooled Analysis of 31,640 Patients’ Data

KHANRA¹,

MANIVANNAN²,

MUKHERJEE³

et al. 2022

J Innov Cardiac Rhythm Manage.

View full text Add to dashboard Cite

Among primary prevention implantable cardioverter-defibrillator (ICD) recipients, 75% do not experience any appropriate ICD therapies during their lifetime, and nearly 25% have improvements in their left ventricular ejection fraction (LVEF) during the lifespan of their first generator. The practice guidelines concerning this subgroup's clinical need for generator replacement (GR) remain unclear. We conducted a proportional meta-analysis to determine the incidence and predictors of ICD therapies after GR and compared this to the immediate and longterm complications. A systematic review of existing literature on ICD GR was performed. Selected studies were critically appraised using the Newcastle-Ottawa scale. Outcomes data were analyzed by random-effects modeling using R (R Foundation for Statistical Computing, Vienna, Austria), and covariate analyses were conducted using the restricted maximum likelihood function. A total of 31,640 patients across 20 studies were included in the meta-analysis with a median (range) follow-up of 2.9 (1.2-8.1) years. The incidences of total therapies, appropriate shocks, and antitachycardia pacing post-GR were approximately 8, 4, and 5 per 100 patient-years, respectively, corresponding to 22%, 12%, and 12% of patients of the total cohort, with a high level of heterogeneity across the studies. Greater anti-arrhythmic drug use and previous shocks were associated with ICD therapies post-GR. The all-cause mortality was approximately 6 per 100 patient-years, corresponding to 17% of the cohort. Diabetes mellitus, atrial fibrillation, ischemic cardiomyopathy, and the use of digoxin were predictors of all-cause mortality in the univariate analysis; however, none of these were found to be significant predictors in the multivariate analysis. The incidences of inappropriate shocks and other procedural complications were 2 and 2 per 100 patient-years, respectively, which corresponded to 6% and 4% of the entire cohort. Patients undergoing ICD GR continue to require therapy in a significant proportion of cases without any correlation with an improvement in LVEF. Further prospective studies are necessary to risk-stratify ICD patients undergoing GR.

show abstract

Section: Resultsmentioning

confidence: 99%

Incidence and Predictors of Implantable Cardioverter-defibrillator Therapies After Generator Replacement—A Pooled Analysis of 31,640 Patients’ Data

KHANRA¹,

MANIVANNAN²,

MUKHERJEE³

et al. 2022

J Innov Cardiac Rhythm Manage.

View full text Add to dashboard Cite

show abstract

“…Our results also are consistent with a prior study that evaluated a similar patient cohort to ours and found that of 125 patients with generator replacements for primary prevention, 55 (44%) had recovered their LVEF to ≥50%, and of these patients, none required ATP or shocks. 18 Furthermore, with over 400 participants, our study is the largest to date focused on patients with primary prevention ICDs without prior appropriate ICD therapy, and is the most contemporary. Most prior studies evaluating ICD therapy in recovered LVEF have either included patients with appropriate ICD therapy before generator change, or included patients with secondary-prevention ICD implants.…”

Section: Discussionmentioning

confidence: 99%

Risk of ventricular arrhythmias following implantable cardioverter‐defibrillator generator change in patients with recovered ejection fraction: Implications for shared decision‐making

Chang

Pantlin

Benn

et al. 2023

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction: Guidelines indicate primary-prevention implantable cardioverterdefibrillators (ICDs) for most patients with left ventricular ejection fraction (LVEF) ≤ 35%. Some patients' LVEFs improve during the life of their first ICD. In patients with recovered LVEF who never received appropriate ICD therapy, the utility of generator replacement upon battery depletion remains unclear. Here, we evaluate ICD therapy based on LVEF at the time of generator change, to educate shared decision-making regarding whether to replace the depleted ICD. Methods:We followed patients with a primary-prevention ICD who underwent generator change. Patients who received appropriate ICD therapy for ventricular tachycardia or ventricular fibrillation (VT/VF) before generator change were excluded. The primary endpoint was appropriate ICD therapy, adjusted for the competing risk of death.Results: Among 951 generator changes, 423 met inclusion criteria. During 3.4 ± 2.2 years follow-up, 78 (18%) received appropriate therapy for VT/VF. Compared to patients with recovered LVEF > 35% (n = 161 [38%]), those with LVEF ≤ 35% (n = 262 [62%]) were more likely to require ICD therapy (p = .002; Fine-Gray adjusted 5-year event rates: 12.7% vs. 25.0%). Receiver operating characteristic analysis revealed the optimal LVEF cutoff for VT/VF prediction to be 45%, the use of which further improved risk stratification (p < .001), with Fine-Gray adjusted 5-year rates 6.2% versus 25.1%. Conclusion:Following ICD generator change, patients with primary-prevention ICDs and recovered LVEF have significantly lower risk of subsequent ventricular arrhythmias compared to those with persistent LVEF depression. Risk stratification at LVEF 45% offers significant additional negative predictive value over a 35%

show abstract

“…Lastly, the therapies delivered by the ICD are only a surrogate endpoint and may not be necessarily considered as prevented sudden cardiac death, as episodes of nonsustained ventricular tachycardia frequently terminate spontaneously [16]. However, this approach was previously adopted by other Authors [5], [6] and, in our opinion, is the only feasible in a retrospective setting.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have shown that a proportion of patients implanted for primary prevention of sudden death improve their LVEF after ICD implantation [2], [3], [4], [5], [6], especially if treated with cardiac resynchronization therapy ICD (CRT-D).…”

Section: Introductionmentioning

confidence: 99%

Persistence of ICD indication at the time of replacement in patients with initial implant for primary prevention indication: Effect on subsequent ICD therapies

Dell’Era¹,

Degiovanni²,

Occhetta³

et al. 2017

Indian Pacing and Electrophysiology Journal

View full text Add to dashboard Cite

BackgroundIndication to implantable cardioverter defibrillator (ICD) for primary prevention of sudden death relies on left ventricular ejection fraction (LVEF). We measured the proportion of patients in whom indication to ICD persisted at the time of generator replacement (GR) and searched for predictors of appropriate therapies after GR.MethodsWe identified all consecutive patients who had received an ICD at our hospital, for LVEF ≤35% and no previous arrhythmias or unexplained syncope. Then, we included the 166 patients who outlived their first device and underwent GR.ResultsAt the time of GR (mean follow-up 59 ± 20 months), ICD indication (i.e. LVEF ≤35% or previously treated ventricular arrhythmias) persisted in 114 (69%) patients. After GR, appropriate ICD therapies were delivered in 30 (26%) patients with persistent ICD indication and in 12 (23%) of the remaining patients (p = 0.656). Nonetheless, the annual rate of therapies was higher in the first group (1.08 versus 0.53 events/year; p < 0.001), as well as the rate of inappropriate therapies (0.03 versus 0 events/year; p = 0.031). The only independent predictor of appropriate ICD therapies after GR was the rate of shocks received before replacement (Hazard Ratio: 1.41; 95% confidence interval: 1.01–1.96; p = 0.041).ConclusionIn heart failure with reduced LVEF, ICD indication persisted at the time of GR in 69% of patients. However, even in the absence of persistent ICD indication at GR, the risk of recurrence of arrhythmic events was not null.

show abstract

Normalization of Left Ventricular Ejection Fraction and Incidence of Appropriate Antitachycardia Therapy in Patients With Implantable Cardioverter Defibrillator for Primary Prevention of Sudden Death

Cited by 14 publications

References 16 publications

Incidence and Predictors of Implantable Cardioverter-defibrillator Therapies After Generator Replacement—A Pooled Analysis of 31,640 Patients’ Data

Incidence and Predictors of Implantable Cardioverter-defibrillator Therapies After Generator Replacement—A Pooled Analysis of 31,640 Patients’ Data

Risk of ventricular arrhythmias following implantable cardioverter‐defibrillator generator change in patients with recovered ejection fraction: Implications for shared decision‐making

Persistence of ICD indication at the time of replacement in patients with initial implant for primary prevention indication: Effect on subsequent ICD therapies

Contact Info

Product

Resources

About