Abstract 12487: Evaluation of the Need of Elective Implantable Cardioverter-Defibrillator Generator Replacement in Primary Prevention Patients Without Prior Appropriate ICD Therapy
Introduction: It is not clear whether patients who received an implantable cardioverter defibrillator (ICD) for primary prevention should undergo device replacement when they never experienced an appropriate ICD therapy during first generator longevity. This study evaluated the incidence and predictors of appropriate ICD therapy after device replacement in this specific population.
Methods and Results: From 2 large prospective ICD registries we identified all primary prevention patients who had a first ICD replacement without previous appropriate ICD therapy. Of 403 primary prevention patients needing first ICD replacement, 275 (68.2%) patients had not received previous appropriate ICD therapy. The study population comprised 266 patients (61.6 ± 12.2 years at replacement, 74.8% male) with adequate follow-up (9 patients were lost to follow-up). Mean follow-up was 86.2 ± 24.4 months after the initial implantation and 30.3 ± 24.2 months after device replacement. The cumulative event rate for appropriate ICD therapy after device replacement was 8.8% at 1 year, 10.9% at 2 years, and 13.7% at 3 years. Multivariable Cox regression analysis identified non-ischemic cardiomyopathy (NICMP) (hazard ratio [HR], 0.43; 95% confidence interval [CI], 0.19-0.99; P = 0.047) and the use of beta-blockers (HR, 0.41; 95% CI, 0.19-0.88, P = 0.02) as independent factors associated with a lower incidence of appropriate ICD therapy. In NICMP patients using beta-blockers, the cumulative event rate for appropriate ICD therapy after device replacement was 4.1% at 3 years (Figure).
Conclusion: A substantial number of primary prevention patients without previous appropriate ICD therapy received appropriate ICD therapy after first device replacement. However, non-ischemic cardiomyopathy patients represent a low arrhythmic subgroup and the benefit of elective ICD replacement seems less clear in this population.
- Implantable cardioconvert defibrillator
- Ventricular arrhythmia
- Heart failure
- Myocardial infarction
- © 2013 by American Heart Association, Inc.