Incidence and risk factors for first and recurrent ICD shock therapy in patients with an implantable cardioverter defibrillator.

Autor: Frodi DM; Department of Cardiology, The Heart Center, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, DK-2100, Copenhagen, Denmark., Diederichsen SZ; Department of Cardiology, The Heart Center, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, DK-2100, Copenhagen, Denmark., Xing LY; Department of Cardiology, The Heart Center, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, DK-2100, Copenhagen, Denmark., Spona DC; Department of Cardiology, The Heart Center, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, DK-2100, Copenhagen, Denmark., Jacobsen PK; Department of Cardiology, The Heart Center, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, DK-2100, Copenhagen, Denmark., Risum N; Department of Cardiology, The Heart Center, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, DK-2100, Copenhagen, Denmark., Svendsen JH; Department of Cardiology, The Heart Center, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 7, DK-2100, Copenhagen, Denmark. jesper.hastrup.svendsen@regionh.dk.; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark. jesper.hastrup.svendsen@regionh.dk.
Jazyk: angličtina
Zdroj: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2024 Aug 21. Date of Electronic Publication: 2024 Aug 21.
DOI: 10.1007/s10840-024-01873-0
Abstrakt: Background: Advances in medical treatment and outcomes in implantable cardioverter-defibrillator (ICD) recipients incentivize a need for improved candidate selection and identification of risk factors for ICD therapy. We examined contemporary rates of and risk factors for ICD therapy.
Methods: Patients with ICD for primary (PP) or secondary prevention (SP), implanted between January 2010 and December 2020, were followed for appropriate and inappropriate incident and recurrent shock.
Results: Overall, 2998 patients (mean age 61.8 ± 12.7 years, 20% female, 73% ICD carriers, and 47.1% SP) were analyzed with a median follow-up of 4.3 (interquartile range (IQR) 2.1-7.4) years. A total of 426/2998 (14.2%) patients had shock; 364/2998 (12.1%) had appropriate and 82/2998 (2.7%) inappropriate shock, with annualized event rates of 2.34 (2.11-2.59) and 0.49 (0.39-0.61) per 100 person-years, respectively. Of those with shock, 133/364 (36.5%) experienced recurrent appropriate shock and 8/364 (2.2%) received recurrent inappropriate shock, with event rates of 10.57 (8.85-12.53) and 0.46 (0.20-0.92), respectively. In multivariable analyses, female sex was associated with a reduced risk of incident appropriate shock (hazard ratio 0.69 [95% confidence interval 0.52; 0.91]). Of other variables, only revascularization status was associated with recurrent appropriate shock in PP, and CRT-D with recurrent appropriate shock in the overall cohort.
Conclusion: One in eight ICD recipients received appropriate shock 2-7 years after guideline-directed implantation. More than one-third of patients with a first shock experienced recurrent shock. Few clinical variables showed potential in predicting shocks, illustrating a need for more advanced tools to select candidates for implantation.
(© 2024. The Author(s).)
Databáze: MEDLINE
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