Riccardo Proietti1, Christopher Labos2, Mark Davis2, George Thanassoulis2, Pasquale Santangeli3, Vincenzo Russo4, Luigi Di Biase5, Jean-Francois Roux6, Atul Verma7, Andrea Natale8, Vidal Essebag9. 1. McGill University Health Center, Montréal, Québec, Canada; Cardiology Department, Luigi Sacco Hospital, Milan, Italy. Electronic address: riccardoproietti6@gmail.com. 2. McGill University Health Center, Montréal, Québec, Canada. 3. Cardiology Department, University of Pennsylvania, Philadelphia, Pennsylvania, USA. 4. Second Chair of Cardiology, Monaldi Hospital, Naples, Italy. 5. Texas Cardiac Arrhythmias Institute, St. Davids Medical Center, Austin, Texas, USA; Albert Einstein College of Medicine at Montefiore Hospital, New York, New York, USA. 6. McGill University Health Center, Montréal, Québec, Canada; Division of Cardiology, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada. 7. McGill University Health Center, Montréal, Québec, Canada; Southlake Regional Health Centre, Newmarket, Ontario, Canada. 8. Texas Cardiac Arrhythmias Institute, St. Davids Medical Center, Austin, Texas, USA; Case Western Reserve University, Cleveland, Ohio, USA; EP Services, California Pacific Medical Center, San Francisco, California, USA; Interventional Electrophysiology, Scripps Clinic, San Diego, California, USA. 9. McGill University Health Center, Montréal, Québec, Canada; Hôpital Sacré-Cœur de Montréal, Montréal, Québec, Canada.
Abstract
BACKGROUND: It is unknown whether implantable cardioverter-defibrillator (ICD) discharges actively contribute to a worse prognosis independent of the underlying arrhythmia. There is considerable variability in the reported risk of mortality after appropriate and inappropriate ICD shocks. The aim of our systematic review was to provide a reliable effect size of the association between ICD shock and mortality for both types of therapies. METHODS: On the basis of a systematic literature search, 10 studies were considered eligible for inclusion in the analysis, and data on the hazard ratio (HR) of mortality after ICD shock were extracted from each study. RESULTS: On pooled analysis, a substantial difference was detected in the risk for subsequent mortality between appropriate and inappropriate shocks. Among patients receiving an appropriate ICD shock, the HR for cardiac death was 2.95 (95% confidence interval [CI], 2.12-4.11; P < 0.001) compared with an HR of 1.71 (95% CI, 1.45-2.02) for those receiving an inappropriate shock. Clinical variables like ejection fraction, New York Heart Association class, and length of follow-up did not affect the HRs in our meta-regression models. CONCLUSIONS: Our analysis showed a significant association between appropriate and inappropriate ICD shocks and mortality, with a stronger association for appropriate shocks. Previous trials of ICD therapy reduction programming have shown a significant reduction of inappropriate shocks. The management of appropriate shocks is more challenging and may be optimized by the assessment and treatment of the underlying ventricular arrhythmias. The role of therapies aimed at modifying the arrhythmic substrate and the potential impact on ICD shocks and mortality requires further investigation. Published by Elsevier Inc.
BACKGROUND: It is unknown whether implantable cardioverter-defibrillator (ICD) discharges actively contribute to a worse prognosis independent of the underlying arrhythmia. There is considerable variability in the reported risk of mortality after appropriate and inappropriate ICD shocks. The aim of our systematic review was to provide a reliable effect size of the association between ICD shock and mortality for both types of therapies. METHODS: On the basis of a systematic literature search, 10 studies were considered eligible for inclusion in the analysis, and data on the hazard ratio (HR) of mortality after ICD shock were extracted from each study. RESULTS: On pooled analysis, a substantial difference was detected in the risk for subsequent mortality between appropriate and inappropriate shocks. Among patients receiving an appropriate ICD shock, the HR for cardiac death was 2.95 (95% confidence interval [CI], 2.12-4.11; P < 0.001) compared with an HR of 1.71 (95% CI, 1.45-2.02) for those receiving an inappropriate shock. Clinical variables like ejection fraction, New York Heart Association class, and length of follow-up did not affect the HRs in our meta-regression models. CONCLUSIONS: Our analysis showed a significant association between appropriate and inappropriate ICD shocks and mortality, with a stronger association for appropriate shocks. Previous trials of ICD therapy reduction programming have shown a significant reduction of inappropriate shocks. The management of appropriate shocks is more challenging and may be optimized by the assessment and treatment of the underlying ventricular arrhythmias. The role of therapies aimed at modifying the arrhythmic substrate and the potential impact on ICD shocks and mortality requires further investigation. Published by Elsevier Inc.
Authors: Amit Kaura; Nicholas Sunderland; Ravi Kamdar; Edward Petzer; Theresa McDonagh; Francis Murgatroyd; Para Dhillon; Paul Scott Journal: J Interv Card Electrophysiol Date: 2017-04-06 Impact factor: 1.900
Authors: Vincenzo Russo; Andrea Antonio Papa; Anna Rago; Paola D'Ambrosio; Giovanni Cimmino; Alberto Palladino; Luisa Politano; Gerardo Nigro Journal: Acta Myol Date: 2016-10