Clinical Profile and Incidence of Ventricular Arrhythmia in Patients Undergoing Defibrillator Generator Replacement in Spain

• Published in: Revista española de cardiología (English ed.) 2014-12, Vol.67 (12), p.986-992
• Main Authors: Fontenla, Adolfo, López Gil, María, Martínez Ferrer, José, Alzueta, Javier, Fernández Lozano, Ignacio, Viñolas, Xavier, Rodríguez, Aníbal, Fernández de la Concha, Joaquín, Anguera, Ignasi, Arribas, Fernando
• Format: Article
• Language: English
• Subjects: Appropriate therapies; Arrhythmias, Cardiac - epidemiology; Arrhythmias, Cardiac - therapy; Arritmias ventriculares; Defibrillators, Implantable - adverse effects; Desfibrilador automático implantable; Equipment Failure; Female; Generator replacement; Humans; Implantable cardioverter-defibrillator; Incidence; Male; Middle Aged; Recambio de generador; Retrospective Studies; Risk Assessment; Sex Factors; Spain - epidemiology; Terapias apropiadas; Ventricular arrhythmias
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/j.rec.2014.01.018

Implantable cardioverter-defibrillators reduce mortality in some patients with heart disease. Battery replacement is a frequent occurrence in clinical practice and is required in up to 30% of implants. The benefit/risk ratio of defibrillators varies over time and should be reevaluated at the time of replacement. The aim of this study was to determine the clinical characteristics and incidence of defibrillator therapies in patients who underwent generator replacement. This multicenter retrospective study involved patients from the UMBRELLA national registry who underwent replacement due to defibrillator battery depletion. The incidence of ventricular arrhythmias was determined via remote monitoring. Risk factors for sustained ventricular arrhythmia after replacement were analyzed. A total of 354 patients were included (mean age [standard deviation], 61.8 [14.5] years; men, 80%; secondary prevention, 42%; ventricular arrhythmias in the explanted generator, 62%). After a 25-month follow-up, 70 patients (20%) received appropriate therapies and 8 (2.3%) received inappropriate discharges. Male sex, structural heart disease, heart failure, and the absence of resynchronization were independent predictors of ventricular arrhythmia occurrence. One-fifth of patients had appropriate defibrillator therapies in the first 2 years after generator replacement. Determination of the factors associated with arrhythmia occurrence after replacement may be useful to optimize implantable cardioverter-defibrillator treatment. Se ha demostrado que los desfibriladores automáticos implantables reducen la mortalidad de ciertos pacientes con cardiopatía. El recambio de su batería es una situación frecuente en la práctica clínica, hasta un 30% de los implantes. El beneficio/riesgo del desfibrilador no es constante en el tiempo, y debe revaluarse en el momento del recambio. El objetivo del estudio es conocer las características clínicas y la incidencia de terapias del desfibrilador en los pacientes sometidos a un recambio de generador. Se realizó un estudio retrospectivo multicéntrico basado en los pacientes del registro nacional UMBRELLA, sometidos a recambio por agotamiento de la batería del desfibrilador. Se analizó la incidencia de arritmias ventriculares mediante monitorización a distancia. Se analizaron los factores de riesgo de arritmia ventricular sostenida tras el recambio. Se incluyó a 354 pacientes (media de edad, 61,8 ± 14,5 años; varones, 80%; prevención secundaria, 42%; arr