BACKGROUND: Guidelines provide extensive recommendations regarding implantable cardioverter-defibrillator (ICD) implantation. However, ICD replacement at the time of battery depletion is rarely studied. HYPOTHESIS: Our objectives were to identify patients at high-risk of death after ICD replacement, with a reassessment of changes in risk factors and comorbidities at the time of replacement, and to determine predictors for subsequent mortality. METHODS: Patients undergoing ICD replacement for regular battery depletion were selected from a prospective single-center ICD registry. Both at implant and replacement, 3 demographic parameters, 9 cardiovascular parameters, 5 comorbidities, and 4 laboratory parameters were collected. Cox proportional hazard analyses were used. RESULTS: We included 308 patients who were predominantly male (86%) with a median age at ICD replacement of 66 years. Replacement was performed 65 months (interquartile range, 52-91) after implantation. Median follow-up after replacement was 41 months, during which 82 patients (27%) died. Multivariable analysis revealed 4 independent predictors of mortality after ICD replacement: age/year (hazard ratio [HR]: 1.05, 95% confidence interval [CI]: 1.03-1.08, P = 0.01), worsening heart failure by 1 class (HR: 1.53, 95% CI: 1.15-2.03, P = 0.003), presence of left bundle branch block (HR: 1.98, 95% CI: 1.22-3.23, P = 0.006), and ICD therapy prior to replacement (HR: 2.22, 95% CI: 1.37-3.58, P = 0.001). Incorporated into a dichotomous score, they strongly correlated with mortality at 5 years after replacement (5% with 0 parameters, 15% with 1 parameter, and 30%-55% with >2 parameters). CONCLUSIONS: Focused reassessment of selected patient characteristics at the time of ICD replacement correlates with subsequent mortality and can impact decision making at this point in time.
BACKGROUND: Guidelines provide extensive recommendations regarding implantable cardioverter-defibrillator (ICD) implantation. However, ICD replacement at the time of battery depletion is rarely studied. HYPOTHESIS: Our objectives were to identify patients at high-risk of death after ICD replacement, with a reassessment of changes in risk factors and comorbidities at the time of replacement, and to determine predictors for subsequent mortality. METHODS:Patients undergoing ICD replacement for regular battery depletion were selected from a prospective single-center ICD registry. Both at implant and replacement, 3 demographic parameters, 9 cardiovascular parameters, 5 comorbidities, and 4 laboratory parameters were collected. Cox proportional hazard analyses were used. RESULTS: We included 308 patients who were predominantly male (86%) with a median age at ICD replacement of 66 years. Replacement was performed 65 months (interquartile range, 52-91) after implantation. Median follow-up after replacement was 41 months, during which 82 patients (27%) died. Multivariable analysis revealed 4 independent predictors of mortality after ICD replacement: age/year (hazard ratio [HR]: 1.05, 95% confidence interval [CI]: 1.03-1.08, P = 0.01), worsening heart failure by 1 class (HR: 1.53, 95% CI: 1.15-2.03, P = 0.003), presence of left bundle branch block (HR: 1.98, 95% CI: 1.22-3.23, P = 0.006), and ICD therapy prior to replacement (HR: 2.22, 95% CI: 1.37-3.58, P = 0.001). Incorporated into a dichotomous score, they strongly correlated with mortality at 5 years after replacement (5% with 0 parameters, 15% with 1 parameter, and 30%-55% with >2 parameters). CONCLUSIONS: Focused reassessment of selected patient characteristics at the time of ICD replacement correlates with subsequent mortality and can impact decision making at this point in time.
Authors: Silvia G Priori; Carina Blomström-Lundqvist; Andrea Mazzanti; Nico Blom; Martin Borggrefe; John Camm; Perry Mark Elliott; Donna Fitzsimons; Robert Hatala; Gerhard Hindricks; Paulus Kirchhof; Keld Kjeldsen; Karl-Heinz Kuck; Antonio Hernandez-Madrid; Nikolaos Nikolaou; Tone M Norekvål; Christian Spaulding; Dirk J Van Veldhuisen Journal: Rev Esp Cardiol (Engl Ed) Date: 2016-02
Authors: Guido H Van Welsenes; Johannes B Van Rees; Joep Thijssen; Serge A Trines; Lieselot Van Erven; Martin J Schalij; C J W Borleffs Journal: J Cardiovasc Electrophysiol Date: 2011-07-21
Authors: Gust H Bardy; Kerry L Lee; Daniel B Mark; Jeanne E Poole; Douglas L Packer; Robin Boineau; Michael Domanski; Charles Troutman; Jill Anderson; George Johnson; Steven E McNulty; Nancy Clapp-Channing; Linda D Davidson-Ray; Elizabeth S Fraulo; Daniel P Fishbein; Richard M Luceri; John H Ip Journal: N Engl J Med Date: 2005-01-20 Impact factor: 91.245
Authors: Arthur J Moss; Henry Greenberg; Robert B Case; Wojciech Zareba; W Jackson Hall; Mary W Brown; James P Daubert; Scott McNitt; Mark L Andrews; Adam D Elkin Journal: Circulation Date: 2004-12-06 Impact factor: 29.690
Authors: Mina K Chung; Richard G Holcomb; Suneet Mittal; Jonathan S Steinberg; Marye J Gleva; Theofanie Mela; Daniel Z Uslan; Kevin Mitchell; Jeanne E Poole Journal: Circ Arrhythm Electrophysiol Date: 2014-09-14