Cyril Zakine1, Rodrigue Garcia2, Kumar Narayanan1,3, Estelle Gandjbakhch4, Vincent Algalarrondo5, Nicolas Lellouche6, Marie-Cécile Perier1,7, Laurent Fauchier8, Daniel Gras9, Pierre Bordachar10, Olivier Piot11, Dominique Babuty8, Nicolas Sadoul12, Pascal Defaye13, Jean-Claude Deharo14, Didier Klug15, Christophe Leclercq16, Fabrice Extramiana17, Serge Boveda18, Eloi Marijon1,7,19. 1. Paris Cardiovascular Research Center, Paris, France. 2. University Hospital of Poitiers, Poitiers, France. 3. Maxcure Hospitals, Hyderabad, India. 4. La Pitié Salpêtrière Hospital, Paris, France. 5. Antoine-Béclère Hospital, Paris, France. 6. Henri Mondor Hospital, Paris, France. 7. European Georges Pompidou Hospital, Cardiology Department, Paris, France. 8. Tours University Hospital, Tours, France. 9. Hopital privé du Confluent, Nantes, France. 10. University Hospital od Bordeaux, Bordeaux, France. 11. Centre Cardiologique du Nord, Saint Denis, France. 12. Nancy University Hospital, Nancy, France. 13. University Hospital of Grenoble, Grenoble, France. 14. La Timone University Hospital, Marseille, France. 15. Lille University Hospital, Lille, France. 16. Rennes University Hospital, Université de Rennes, CIC-IT, Rennes, France. 17. Bichat-Claude-Bernard Hospital, Paris, France. 18. Clinique Pasteur, Toulouse, France. 19. Paris Descartes University, Paris, France.
Abstract
AIMS: Current guidelines do not propose any age cut-off for the primary prevention implantable cardioverter-defibrillator (ICD). However, the risk/benefit balance in the very elderly population has not been well studied. METHODS AND RESULTS: In a multicentre French study assessing patients implanted with an ICD for primary prevention, outcomes among patients aged ≥80 years were compared with <80 years old controls matched for sex and underlying heart disease (ischaemic and dilated cardiomyopathy). A total of 300 ICD recipients were enrolled in this specific analysis, including 150 patients ≥80 years (mean age 81.9 ± 2.0 years; 86.7% males) and 150 controls (mean age 61.8 ± 10.8 years). Among older patients, 92 (75.6%) had no more than one associated comorbidity. Most subjects in the elderly group got an ICD as part of a cardiac resynchronization therapy procedure (74% vs. 46%, P < 0.0001). After a mean follow-up of 3.0 ± 2 years, 53 patients (35%) in the elderly group died, including 38.2% from non cardiovascular causes of death. Similar proportion of patients received ≥1 appropriate therapy (19.4% vs. 21.6%; P = 0.65) in the elderly group and controls, respectively. There was a trend towards more early perioperative events (P = 0.10) in the elderly, with no significant increase in late complications (P = 0.73). CONCLUSION: Primary prevention ICD recipients ≥80 years in the real world had relatively low associated comorbidity. Rates of appropriate therapies and device-related complications were similar, compared with younger subjects. Nevertheless, the inherent limitations in interpreting observational data on this particular competing risk situation call for randomized controlled trials to provide definitive answers. Meanwhile, a careful multidisciplinary evaluation is needed to guide patient selection for ICD implantation in the elderly population. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Current guidelines do not propose any age cut-off for the primary prevention implantable cardioverter-defibrillator (ICD). However, the risk/benefit balance in the very elderly population has not been well studied. METHODS AND RESULTS: In a multicentre French study assessing patients implanted with an ICD for primary prevention, outcomes among patients aged ≥80 years were compared with <80 years old controls matched for sex and underlying heart disease (ischaemic and dilated cardiomyopathy). A total of 300 ICD recipients were enrolled in this specific analysis, including 150 patients ≥80 years (mean age 81.9 ± 2.0 years; 86.7% males) and 150 controls (mean age 61.8 ± 10.8 years). Among older patients, 92 (75.6%) had no more than one associated comorbidity. Most subjects in the elderly group got an ICD as part of a cardiac resynchronization therapy procedure (74% vs. 46%, P < 0.0001). After a mean follow-up of 3.0 ± 2 years, 53 patients (35%) in the elderly group died, including 38.2% from non cardiovascular causes of death. Similar proportion of patients received ≥1 appropriate therapy (19.4% vs. 21.6%; P = 0.65) in the elderly group and controls, respectively. There was a trend towards more early perioperative events (P = 0.10) in the elderly, with no significant increase in late complications (P = 0.73). CONCLUSION: Primary prevention ICD recipients ≥80 years in the real world had relatively low associated comorbidity. Rates of appropriate therapies and device-related complications were similar, compared with younger subjects. Nevertheless, the inherent limitations in interpreting observational data on this particular competing risk situation call for randomized controlled trials to provide definitive answers. Meanwhile, a careful multidisciplinary evaluation is needed to guide patient selection for ICD implantation in the elderly population. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Cornelia Scheurlen; Jan van den Bruck; Jonas Wörmann; Tobias Plenge; Arian Sultan; Daniel Steven; Jakob Lüker Journal: Herzschrittmacherther Elektrophysiol Date: 2021-01-29