Long-term outcome of implantable cardioverter–defibrillator implantation in secondary prevention of sudden cardiac death

• Published in: Archives of cardiovascular diseases 2016-10, Vol.109 (10), p.517-526
• Main Authors: Boulé, Stéphane, Sémichon, Marc, Guédon-Moreau, Laurence, Drumez, Élodie, Kouakam, Claude, Marquié, Christelle, Brigadeau, François, Kacet, Salem, Potelle, Charlotte, Escande, William, Souissi, Zouheir, Lacroix, Dominique, Duhamel, Alain, Klug, Didier
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cardiovascular; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - prevention & control; Defibrillators, Implantable; Défibrillateur automatique implantable; Electrocardiography; Female; Fibrillation ventriculaire; Follow-Up Studies; France - epidemiology; Humans; Implantable cardioverter–defibrillator; Internal Medicine; Male; Middle Aged; Mort subite; Prévention secondaire; Retrospective Studies; Risk Factors; Secondary prevention; Secondary Prevention - methods; Sudden cardiac death; Survival Rate - trends; Tachycardia, Ventricular - mortality; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - therapy; Tachycardie ventriculaire; Time Factors; Ventricular fibrillation; Ventricular tachycardia; Young Adult
• ISSN: 1875-2136; 1875-2128
• DOI: 10.1016/j.acvd.2016.02.008

Summary Background Little is known about the long-term outcomes of patients who receive an implantable cardioverter–defibrillator (ICD) for purely secondary prevention indications. Aims To assess the rates and predictors of appropriate therapies over a very long-term follow-up period in this population. Methods Between June 2003 and August 2006, 239 consecutive patients with structural left ventricular disease and a secondary prophylaxis indication for ICD therapy (survivors of life-threatening ventricular tachyarrhythmias) were prospectively enrolled. An extended follow-up of these patients was carried out. The primary endpoint was the occurrence of appropriate device therapy. Secondary endpoints were all-cause death, electrical storm and inappropriate therapy. Results The study population consisted of 239 patients (90% men; mean age 64 ± 12 years; 72% ischaemic cardiomyopathy; left ventricular ejection fraction 37 ± 12%). During a median follow-up of 7.8 (3.5–9.3) years, appropriate device therapy occurred in 139 (58.2%) patients. Death occurred in 141 patients (59%), electrical storm in 73 (30.5%) and inappropriate therapy in 42 (17.6%). Multivariable analysis identified patients whose presenting arrhythmia was ventricular fibrillation as being less likely to require appropriate device therapy than those whose presenting arrhythmia was ventricular tachycardia (sub-hazard ratio 0.62, 95% confidence interval 0.40–0.97; P = 0.04). Independent predictors of all-cause death were age at implantation ( P < 0.0001), wide QRS complexes ( P = 0.024), creatinine concentration ( P = 0.0002) and B-type natriuretic peptide at implantation ( P = 0.0001). Conclusion Secondary prevention ICD recipients exhibit a high risk of appropriate device therapy and death over prolonged follow-up. Patients who presented initially with ventricular fibrillation were less likely to require the delivery of appropriate device therapy.