Risk of Appropriate Therapy and Death Before Therapy After Implantable Cardioverter-Defibrillator Generator Replacement

BACKGROUNDThe decision to initially implant an implantable cardioverter-defibrillator (ICD) is informed by robust randomized controlled trials, but no such data exist to guide the decision to replace an ICD generator. In this study, we aimed to determine outcomes after ICD generator replacement. MET...

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Bibliographic Details
Published in:	Circulation. Arrhythmia and electrophysiology Vol. 11; no. 8; p. e006155
Main Authors:	Witt, Chance M, Waks, Jonathan W, Mehta, Ramila A, Friedman, Paul A, Kramer, Daniel B, Buxton, Alfred E, Mulpuru, Siva K, Noseworthy, Peter A, Hodge, David O, Lushinsky, Emilie C, Mulholland, Megan B, Cha, Yong-Mei, Gersh, Bernard J, Madhavan, Malini
Format:	Journal Article
Language:	English
Published:	United States American Heart Association, Inc 01-08-2018
Subjects:	Aged Aged, 80 and over Boston Cardiomyopathies - diagnosis Cardiomyopathies - mortality Cardiomyopathies - physiopathology Cardiomyopathies - therapy Clinical Decision-Making Comorbidity Databases, Factual Defibrillators, Implantable Device Removal - adverse effects Device Removal - mortality Electric Countershock - adverse effects Electric Countershock - instrumentation Electric Countershock - mortality Female Health Status Heart Failure - diagnosis Heart Failure - mortality Heart Failure - physiopathology Heart Failure - therapy Humans Life Expectancy Male Middle Aged Minnesota Patient Selection Prosthesis Failure Quality of Life Recovery of Function Retrospective Studies Risk Assessment Risk Factors Stroke Volume Time Factors Treatment Outcome Ventricular Function, Left Minnesota Boston primary prevention diabetes mellitus secondary prevention death glomerular filtration rate
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Summary:	BACKGROUNDThe decision to initially implant an implantable cardioverter-defibrillator (ICD) is informed by robust randomized controlled trials, but no such data exist to guide the decision to replace an ICD generator. In this study, we aimed to determine outcomes after ICD generator replacement. METHODSAll patients with ischemic or nonischemic cardiomyopathy who underwent ICD generator replacement from 2001 to 2011 at Mayo Clinic, MN, or Beth Israel Deaconess Medical Center, MA, were included. Outcomes included (1) appropriate therapy after generator replacement and (2) death before appropriate therapy after generator replacement. Cox proportional hazards modeling was used to determine the associations between patient characteristics and outcomes. RESULTSIn 1421 patients undergoing ICD generator replacement (mean±SD age 69.6±12.1 years, 81% male), appropriate therapy occurred after replacement in 435 patients (30.6%) over a mean follow-up of 2.7±2.6 years. Associated factors included lower left ventricular ejection fraction and history of appropriate therapy before generator replacement. Death before appropriate ICD therapy occurred in 336 (23.7%) patients. Older age, lower left ventricular ejection fraction, and noncardiac comorbidities, including diabetes mellitus, chronic lung disease, peripheral vascular disease, lower hemoglobin, and lower glomerular filtration rate, were associated with greater risk of death before appropriate therapy. A progressive increase in mortality was observed with aggregation of these noncardiac comorbidities. CONCLUSIONSThe decision to replace the ICD should take into consideration not only left ventricular ejection fraction and history of ventricular arrhythmias, but also comorbid illnesses that may impact the duration and the quality of life.
ISSN:	1941-3149 1941-3084
DOI:	10.1161/CIRCEP.117.006155