Abstract 17740: Prognosis of Patients with Primary Prevention ICDs Implanted Outside of Current Guidelines
According to recently published data from the United States Implantable Cardioverter-Defibrillator (ICD) Registry, 22.5% of ICDs placed for primary prevention are implanted outside of evidence-based guideline indications (OE). The majority of patients implanted OE had a perceived increased risk of arrhythmic death resulting in ICD implantation before such therapy would be recommended. We hypothesize that patients selected for primary prevention ICD placement within guideline indications (WE) and those OE will have similar life expectancy, and that patients with ICDs placed OE will receive increased appropriate ICD therapy. A retrospective study was performed on 198 consecutive recipients of primary prevention ICDs at three institutions between January 1, 2006 and December 31, 2010. Subjects were grouped by whether ICD placement occurred WE or OE, based on current evidence-based guidelines. The groups were analyzed for time from implant to therapy or death, as well as appropriateness of therapy delivered. During the 5-year inclusion period, 19% of primary prevention ICDs were placed OE within our study population. During the first six months following device placement, more subjects died in the OE group (7.9%) compared to the WE group (0.63%) (p=0.004). During this time, there was no significant difference in the incidence of appropriate ICD therapy between the two groups (p=0.380). However, subjects with ICDs placed OE were more likely to receive an inappropriate shock (p=0.034) (Figure 1). In our study population, subjects with ICD placement OE have an increased 6-month mortality rate following device implant, yet no significant increase in the incidence of appropriate ICD therapy compared to ICDs placed WE. Additionally, patients with ICDs placed OE have an increased incidence of inappropriate ICD therapy. Our data suggests that patients with OE ICD implantation have worse survival without increased rates of appropriate ICD therapies.
- © 2012 by American Heart Association, Inc.