Comparison of Inappropriate Shocks and Other Health Outcomes Between Single- and Dual-Chamber Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death: Results From the Cardiovascular Research Network Longitudinal Study of Implantable Cardioverter-Defibrillators.

Autor: Peterson PN; Denver Health Medical Center, Denver, CO pamela.peterson@ucdenver.edu.; University of Colorado Denver Anschutz Medical Campus, Aurora, CO.; Institute for Health Research, Kaiser Permanente Colorado, Denver, CO., Greenlee RT; Marshfield Clinic Research Foundation, Marshfield, WI.; Marshfield Clinic, Marshfield, WI., Go AS; Division of Research, Kaiser Permanente Northern California, Oakland, CA.; University of California San Francisco, San Francisco, CA.; Stanford University School of Medicine, Palo Alto, CA., Magid DJ; University of Colorado Denver Anschutz Medical Campus, Aurora, CO.; Institute for Health Research, Kaiser Permanente Colorado, Denver, CO., Cassidy-Bushrow A; Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI., Garcia-Montilla R; Marshfield Clinic Research Foundation, Marshfield, WI., Glenn KA; Institute for Health Research, Kaiser Permanente Colorado, Denver, CO., Gurwitz JH; Meyers Primary Care Institute, Worcester, MA., Hammill SC; Division of Cardiology, Mayo Clinic, Rochester, MN., Hayes J; Marshfield Clinic Research Foundation, Marshfield, WI., Kadish A; Touro College, New York, NY., Reynolds K; Kaiser Permanente Southern California Department of Research and Evaluation, Pasadena, CA., Sharma P; Marshfield Clinic Research Foundation, Marshfield, WI., Smith DH; Kaiser Permanente Northwest Center for Health Research, Portland, OR., Varosy PD; University of Colorado Denver Anschutz Medical Campus, Aurora, CO.; Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.; Eastern Colorado VA Health Care System, Denver, CO., Vidaillet H; Marshfield Clinic Research Foundation, Marshfield, WI., Zeng CX; Institute for Health Research, Kaiser Permanente Colorado, Denver, CO., Normand ST; Harvard Medical School, Boston, MA.; Harvard School of Public Health, Boston, MA., Masoudi FA; University of Colorado Denver Anschutz Medical Campus, Aurora, CO.; Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2017 Nov 09; Vol. 6 (11). Date of Electronic Publication: 2017 Nov 09.
DOI: 10.1161/JAHA.117.006937
Abstrakt: Background: In US clinical practice, many patients who undergo placement of an implantable cardioverter-defibrillator (ICD) for primary prevention of sudden cardiac death receive dual-chamber devices. The superiority of dual-chamber over single-chamber devices in reducing the risk of inappropriate ICD shocks in clinical practice has not been established. The objective of this study was to compare risk of adverse outcomes, including inappropriate shocks, between single- and dual-chamber ICDs for primary prevention.
Methods and Results: We identified patients receiving a single- or dual-chamber ICD for primary prevention who did not have an indication for pacing from 15 hospitals within 7 integrated health delivery systems in the Longitudinal Study of Implantable Cardioverter-Defibrillators from 2006 to 2009. The primary outcome was time to first inappropriate shock. ICD shocks were adjudicated for appropriateness. Other outcomes included all-cause hospitalization, heart failure hospitalization, and death. Patient, clinician, and hospital-level factors were accounted for using propensity score weighting methods. Among 1042 patients without pacing indications, 54.0% (n=563) received a single-chamber device and 46.0% (n=479) received a dual-chamber device. In a propensity-weighted analysis, device type was not significantly associated with inappropriate shock (hazard ratio, 0.91; 95% confidence interval, 0.59-1.38 [ P =0.65]), all-cause hospitalization (hazard ratio, 1.03; 95% confidence interval, 0.87-1.21 [ P =0.76]), heart failure hospitalization (hazard ratio, 0.93; 95% confidence interval, 0.72-1.21 [ P =0.59]), or death (hazard ratio, 1.19; 95% confidence interval, 0.93-1.53 [ P =0.17]).
Conclusions: Among patients who received an ICD for primary prevention without indications for pacing, dual-chamber devices were not associated with lower risk of inappropriate shock or differences in hospitalization or death compared with single-chamber devices. This study does not justify the use of dual-chamber devices to minimize inappropriate shocks.
(© 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.)
Databáze: MEDLINE
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