Experience of ICD management at a UK center: cardiovascularly stable VT presentation predicts higher risk for
Michael Koa-Wing1, Ian Wright, Nicholas S Peters
1Waller Cardiology Department, Imperial College and St. Mary's Hospital, Praed Street, London, United Kingdom. m.koawing@imperial.ac.uk
Insights
Patients with stable ventricular tachycardia (VT) are more likely to receive implantable cardioverter defibrillator (ICD) therapy. Replacement ICDs are as likely to deliver therapy as original devices, aiding risk stratification.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Identifying patients at high risk for implantable cardioverter defibrillator (ICD) therapy is crucial for minimizing treatment-related morbidity.
- Additional antiarrhythmic measures may be considered for high-risk patients.
Purpose of the Study:
- To assess baseline characteristics that predict device therapy in a general ICD population.
- To compare therapy delivery likelihood between initial and replacement ICDs.
Main Methods:
- Analysis of clinical and ICD interrogation data from a UK center.
- Cox regression for univariate and multivariate analysis of predictors for appropriate ICD therapy.
- Log-rank testing to compare time to first appropriate therapy between first and replacement ICDs.
Main Results:
- 161 patients studied; 42% received appropriate ICD therapy.
- Predictors for therapy included stable ventricular tachycardia (VT), ischemic etiology, tiered programming, and beta-blocker use.
- Stable VT and beta-blocker use were independent predictors; replacement ICDs showed no difference in therapy delivery timing.
Conclusions:
- Patients presenting with stable VT have a higher likelihood of receiving appropriate ICD therapy.
- Replacement ICDs are equally likely to deliver therapy as initial implants, suggesting consistent risk profiles.
Background:
It would be useful to identify patients at high risk of implantable cardioverter defibrillator (ICD) therapy via additional antiarrhythmic measures to minimize the morbidity of ICD therapies.
Objective:
We assessed baseline characteristics for predictors of device therapy in a general ICD population. We also compared the likelihood of therapy delivery by replacement ICDs implanted for battery depletion with the original implants.
Methods:
Clinical and ICD interrogation data from patients followed up at a UK center were analyzed looking for predictors of appropriate ICD therapy. Univariate and multivariate analysis was performed using Cox regression. We compared time to first appropriate therapy between first and second ICDs in patients who had undergone ICD replacement for battery depletion by log-rank testing.
Results:
One hundred and sixty-one patients were studied (129 men, age 65.7 +/- 12.9 years, follow-up 908 +/- 676 days). Appropriate therapy was delivered in 68 patients (42%). Univariate risk factors for appropriate ICD therapy were presentation with stable ventricular tachycardia (VT) (P = 0.0002), ischemic etiology (P = 0.03), tiered therapy programmed ICDs (P = 0.01), and beta-blocker use (P = 0.001). Stable VT and beta blocker use were independent predictors of ICD therapy on multivariate analysis. Thirty-three patients (20%) had at least one ICD replacement. Time to first appropriate therapy was no different between first and second ICD implants (P = 0.8).
Conclusion:
Patients who present with cardiovascularly stable VT have a higher probability of receiving appropriate ICD therapy than those who do not. Following battery depletion of an original ICD, the replacement device is no less likely to administer therapy than the first.
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