Purpose: Despite the proven survival benefit of implantable cardioverter-defibrillators (ICDs) there is paucity of data regarding routine clinical practice. The aim of this study was to investigate the predictors of appropriate/inappropriate ICD shocks and their long-term prognostic impact in patients implanted for primary sudden cardiac death (SCD) prevention. Methods: 776 consecutive patients (mean age 64, female 18.9%) undergoing ICD implantation between Jan 2005 and Dec 2010 were included. Baseline characteristics and semestral follow-up visits data were extrapolated from multicenter medical records. Multiple logistic regression models were used to identify significant predictors of ICD shocks. The effect of appropriate and inappropriate shocks on the primary outcome of all-cause death or cardiovascular hospitalization was examined by Cox proportional hazard models adjusting for significant confounders. Results: Over a median follow-up of 29 months (IQR 17-47 months) 185 patients (23.8%) received an ICD shock (99, 72 and 14 receiving appropriate, inappropriate and both shocks respectively). The occurrence of atrial fibrillation during follow-up and an elevated resting heart rate were the two strongest predictors of inappropriate shocks (OR 3.13, 95% CI 1.34–7.30 and OR 1.21, 95% CI 1.02-1.40 [per 10 bpm increase], respectively) which were inversely associated with age (OR 0.81, 95% CI 0.69-0.94 [per 5 yrs increase]). At multivariable survival analysis, appropriate but not inappropriate shocks were significantly associated with the composite outcome of all-cause death or cardiovascular hospitalization (Table 1). Conclusions: In “real-world” patients implanted with ICDs for primary SCD prevention the occurrence of shocks is a common event that negatively influences patients' prognosis and quality of life. Therapeutic strategies aiming at slowing the underlying cardiac disease progression together with optimization of devices programming should always be attempted in order to improve ICDs net clinical benefit.
Appropriate and inappropriate defibrillator shocks: predictors and impact on prognosis in a cohort of patients implanted for primary sudden cardiac death prevention
CASTAGNO, Davide;BISSOLINO, Arianna;ANSELMINO, Matteo;GAITA, Fiorenzo
2014-01-01
Abstract
Purpose: Despite the proven survival benefit of implantable cardioverter-defibrillators (ICDs) there is paucity of data regarding routine clinical practice. The aim of this study was to investigate the predictors of appropriate/inappropriate ICD shocks and their long-term prognostic impact in patients implanted for primary sudden cardiac death (SCD) prevention. Methods: 776 consecutive patients (mean age 64, female 18.9%) undergoing ICD implantation between Jan 2005 and Dec 2010 were included. Baseline characteristics and semestral follow-up visits data were extrapolated from multicenter medical records. Multiple logistic regression models were used to identify significant predictors of ICD shocks. The effect of appropriate and inappropriate shocks on the primary outcome of all-cause death or cardiovascular hospitalization was examined by Cox proportional hazard models adjusting for significant confounders. Results: Over a median follow-up of 29 months (IQR 17-47 months) 185 patients (23.8%) received an ICD shock (99, 72 and 14 receiving appropriate, inappropriate and both shocks respectively). The occurrence of atrial fibrillation during follow-up and an elevated resting heart rate were the two strongest predictors of inappropriate shocks (OR 3.13, 95% CI 1.34–7.30 and OR 1.21, 95% CI 1.02-1.40 [per 10 bpm increase], respectively) which were inversely associated with age (OR 0.81, 95% CI 0.69-0.94 [per 5 yrs increase]). At multivariable survival analysis, appropriate but not inappropriate shocks were significantly associated with the composite outcome of all-cause death or cardiovascular hospitalization (Table 1). Conclusions: In “real-world” patients implanted with ICDs for primary SCD prevention the occurrence of shocks is a common event that negatively influences patients' prognosis and quality of life. Therapeutic strategies aiming at slowing the underlying cardiac disease progression together with optimization of devices programming should always be attempted in order to improve ICDs net clinical benefit.
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