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

Abstract

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.

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

“…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).…”

Incidence of appropriate anti-tachycardia therapies after elective generator replacement in patient with heart failure initially implanted with a defibrillator for primary prevention: Results of a meta-analysis

“…The 6 studies [12][13][14][15][16][17] finally included were retrieved in just the last 4 years of literature review, 3 were published in 2016, 2 in 2014, 1 in 2017. Study design was observational retrospective in all cases.…”

“…Study design was observational retrospective in all cases. One study only reported adjustment for confounding [16]. A total of 733 patients were enrolled in our analysis, 255 in patients without persistent ICD indication and 478 in patients with persistent ICD indication.…”

In sickness and in health, till death do us part: Is the ICD a lifelong commitment?

“…In this manuscript, Dell'era et al. [1] select a group of patients with a primary prevention indication for an ICD who then go on to get a generator exchange, and examine the risk of future arrhythmic events in those with persistent indications for ICD at the time of GE, and those without ongoing indications. In the group of patients who have received prior therapy from their device, the decision to perform a generator exchange is straightforward-prior history of arrhythmic events is the strongest predictor of future arrhythmic events.…”