Abstract 17137: Natural History of the Primary Prevention Implantable Cardioverter Defibrillator Therapy in France (2002-2012)
Introduction: The deployment of the implantable cardioverter defibrillator (ICD) therapy for primary prevention of sudden cardiac death has been introduced later in many European countries compared to North-America. We aimed to evaluate the risk-benefit ratio of this strategy over the last decade in France.
Methods and Results: We analyzed characteristics and outcomes (including specific mortalities) of all patients with coronary artery disease or dilated cardiomyopathy implanted with an ICD in the setting of primary prevention, from 12 public and private French centers (2002-2012). Overall, 5539 patients (age 62.5±11 years, 84.9% male, 60.2% with coronary artery disease) were implanted with ICD, including 2952 (53.8%) associated with cardiac resynchronization therapy. During a median follow-up of 1000 days [466-1667], 1173 patients (22.1%) presented with at least one appropriate therapy, prior battery replacement in a majority (73.2%). On the other hand, 824 patients (15.5%) presented with significant complications including inappropriate therapies in 6.7% and ICD-related death in 0.003%. The annual incidence of ICD-unresponsive sudden cardiac death was estimated to 3.83 per 1000 (95%CI 2,89-4,77). Death occurred in 826 patients (15.3%), principally from progressive heart failure (49.3% of all deaths). Through three periods of time, significant temporal changes were observed with lower incidence of appropriate (0.8 to 0.2 %/patient/year, P<0.0001) and inappropriate (0.2 to 0.07 %/patient/year, P=0.01) therapies. Advanced age, atrial fibrillation, coronary artery disease, higher NYHA class, low ejection fraction and renal insufficiency were independently associated with overall mortality.
Conclusions: Our findings suggest that ICD therapy in primary prevention displayed an apparent favorable risk-benefit profile among heart failure patients in the real life French setting. A better understanding of factors influencing temporal changes needs further investigation.
Author Disclosures: E. Marijon: None. R. Providencia: None. D. Klug: None. P. Defaye: None. M. Perier: None. O. Piot: None. N. Sadoul: None. V. Algalarrondo: None. A. Bouzeman: None. D. Gras: None. L. Fauchier: None. P. Bordachar: None. D. Babuty: None. J. Deharo: None. C. Leclercq: None. S. Boveda: None.
- © 2014 by American Heart Association, Inc.