Stéphane Boulé1, Marc Sémichon2, Laurence Guédon-Moreau2, Élodie Drumez3, Claude Kouakam2, Christelle Marquié2, François Brigadeau2, Salem Kacet4, Charlotte Potelle4, William Escande4, Zouheir Souissi5, Dominique Lacroix4, Alain Duhamel3, Didier Klug4. 1. Department of Cardiovascular Medicine, Lille University Hospital, 59370 Lille, France; Faculty of Medicine, University of Lille 2, 59000 Lille, France. Electronic address: stephane.boule@chru-lille.fr. 2. Department of Cardiovascular Medicine, Lille University Hospital, 59370 Lille, France. 3. Unité de biostatistique, université de Lille, CHU de Lille, EA 2694 - santé publique : épidémiologie et qualité des soins, 59000 Lille, France. 4. Department of Cardiovascular Medicine, Lille University Hospital, 59370 Lille, France; Faculty of Medicine, University of Lille 2, 59000 Lille, France. 5. Faculty of Medicine, University of Lille 2, 59000 Lille, France.
Abstract
BACKGROUND: Little is known about the long-term outcomes of patients who receive an implantable cardioverter-defibrillator (ICD) for purely secondary prevention indications. AIMS: To assess the rates and predictors of appropriate therapies over a very long-term follow-up period in this population. METHODS: Between June 2003 and August 2006, 239 consecutive patients with structural left ventricular disease and a secondary prophylaxis indication for ICD therapy (survivors of life-threatening ventricular tachyarrhythmias) were prospectively enrolled. An extended follow-up of these patients was carried out. The primary endpoint was the occurrence of appropriate device therapy. Secondary endpoints were all-cause death, electrical storm and inappropriate therapy. RESULTS: The study population consisted of 239 patients (90% men; mean age 64±12 years; 72% ischaemic cardiomyopathy; left ventricular ejection fraction 37±12%). During a median follow-up of 7.8 (3.5-9.3) years, appropriate device therapy occurred in 139 (58.2%) patients. Death occurred in 141 patients (59%), electrical storm in 73 (30.5%) and inappropriate therapy in 42 (17.6%). Multivariable analysis identified patients whose presenting arrhythmia was ventricular fibrillation as being less likely to require appropriate device therapy than those whose presenting arrhythmia was ventricular tachycardia (sub-hazard ratio 0.62, 95% confidence interval 0.40-0.97; P=0.04). Independent predictors of all-cause death were age at implantation (P<0.0001), wide QRS complexes (P=0.024), creatinine concentration (P=0.0002) and B-type natriuretic peptide at implantation (P=0.0001). CONCLUSION: Secondary prevention ICD recipients exhibit a high risk of appropriate device therapy and death over prolonged follow-up. Patients who presented initially with ventricular fibrillation were less likely to require the delivery of appropriate device therapy.
BACKGROUND: Little is known about the long-term outcomes of patients who receive an implantable cardioverter-defibrillator (ICD) for purely secondary prevention indications. AIMS: To assess the rates and predictors of appropriate therapies over a very long-term follow-up period in this population. METHODS: Between June 2003 and August 2006, 239 consecutive patients with structural left ventricular disease and a secondary prophylaxis indication for ICD therapy (survivors of life-threatening ventricular tachyarrhythmias) were prospectively enrolled. An extended follow-up of these patients was carried out. The primary endpoint was the occurrence of appropriate device therapy. Secondary endpoints were all-cause death, electrical storm and inappropriate therapy. RESULTS: The study population consisted of 239 patients (90% men; mean age 64±12 years; 72% ischaemic cardiomyopathy; left ventricular ejection fraction 37±12%). During a median follow-up of 7.8 (3.5-9.3) years, appropriate device therapy occurred in 139 (58.2%) patients. Death occurred in 141 patients (59%), electrical storm in 73 (30.5%) and inappropriate therapy in 42 (17.6%). Multivariable analysis identified patients whose presenting arrhythmia was ventricular fibrillation as being less likely to require appropriate device therapy than those whose presenting arrhythmia was ventricular tachycardia (sub-hazard ratio 0.62, 95% confidence interval 0.40-0.97; P=0.04). Independent predictors of all-cause death were age at implantation (P<0.0001), wide QRS complexes (P=0.024), creatinine concentration (P=0.0002) and B-type natriuretic peptide at implantation (P=0.0001). CONCLUSION: Secondary prevention ICD recipients exhibit a high risk of appropriate device therapy and death over prolonged follow-up. Patients who presented initially with ventricular fibrillation were less likely to require the delivery of appropriate device therapy.
Authors: Tayler A Buchan; Crizza Ching; Farid Foroutan; Abdullah Malik; Julian F Daza; Nicholas Ng Fat Hing; Reed Siemieniuk; Nathan Evaniew; Ani Orchanian-Cheff; Heather J Ross; Gordon Guyatt; Ana C Alba Journal: Heart Fail Rev Date: 2021-07-05 Impact factor: 4.214