Abstract 13560: Prevalence and Temporal Trends of Antiarrhythmic Use among ICD Recipients: Findings from the NCDR

Abstract

Introduction: Anti-arrhythmic drugs can affect ICD function; however, patterns of the use of antiarrhythmic drugs among patients with ICDs have not been clearly established.

Methods: We studied patients enrolled in the ICD Registry ^TM between 2006 and 2011 undergoing first-time ICD placement (n=500,995). We analyzed use of antiarrhythmics by class prescribed at discharge after implantation.

Results: 15% of the cohort received an antiarrhythmic. Compared with those not receiving an antiarrhythmic drug, patients receiving an antiarrhythmic were on average older (71 yr vs. 68, p<.01) and more likely to have a history of atrial fibrillation/flutter (58% vs. 27%, p<.01), ventricular tachycardia (53% vs. 30%), or syncope (23% vs. 18%, p<.01). Patients receiving antiarrhythmic drugs were more likely to receive an ICD for secondary prevention (33% vs. 15%, P<.01). Amiodarone was the most commonly used (82%) followed by sotalol (10%) and class I agents (3%). Between 2006 and 2011, there was a modest increase in antiarrhythmic prescription (15% to 16%, P <0.01) with greatest increase among patients who received an ICD for secondary prevention ( 26% to 30%, p<.01) or with a history of ventricular tachycardia (23% to 27%, p<.01) There was modest increase in use among patients with atrial fibrillation (28% to 29%, p<.01) and without atrial fibrillation (9% to 10%, p<.01) but no change in patients receiving primary prevention ICD or CRT-D therapy.

Conclusions: Antiarrhythmic drug use is common among ICD recipients, and this trend is increasing in certain subgroups. Amiodarone is the most commonly used antiarrhythmic drug. Given the toxicities associated with many of these agents, it will be important to develop a greater understanding of the relative benefits and risks of therapy in specific patient populations.