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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
Published on: February 28, 2012
Predictors of early mortality in implantable cardioverter-defibrillator recipients
Kenneth M Stein1, Suneet Mittal, F Roosevelt Gilliam
1Maurice and Corinne Greenberg Division of Cardiology, Department of Medicine, Weill Medical College of Cornell University, 520 East 70th Street, Starr-4, New York, NY 10021, USA. kstein@mail.med.cornell.edu
Insights
Implantable cardioverter defibrillators (ICDs) improve survival, but high mortality persists. Predictors of 1-year death after ICD implantation include atrial fibrillation, diabetes, low BMI, low mean arterial pressure, and poor functional status.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Research
Background:
- Implantable cardioverter defibrillators (ICDs) are proven to prolong survival in patients at risk of sudden cardiac death.
- Despite ICD efficacy in terminating life-threatening arrhythmias, overall mortality remains a significant concern.
Purpose of the Study:
- To identify predictors of 1-year mortality in patients receiving implantable cardioverter defibrillators (ICDs).
- To understand factors contributing to persistent high mortality despite ICD implantation.
Main Methods:
- Evaluation of 1703 patients with conventional ICD indications across 128 US centers between 2001 and 2004.
- Follow-up of patients for up to one year to obtain vital status, with 1-year mortality rate calculated.
Main Results:
- 183 deaths (16% mortality rate) occurred within one year of ICD implantation.
- Key predictors of mortality included atrial fibrillation, diabetes, low body mass index (BMI), low mean arterial pressure (MAP), and poor functional status (New York Heart Association class).
- Multivariate analysis confirmed AF, diabetes, BMI, MAP, and functional class as significant mortality predictors.
Conclusions:
- Poor functional status, low MAP, diabetes, low BMI, and atrial fibrillation are strongly associated with 1-year mortality in patients undergoing ICD implantation.
- These findings highlight specific patient characteristics that may require targeted interventions to improve outcomes post-ICD implantation.
Aims:
Multiple trials have shown that implantable cardioverter defibrillators (ICDs) prolong survival in secondary and primary prevention populations. However, in spite of the efficacy of these devices in terminating life-threatening arrhythmias, total mortality remains high.
Methods And Results:
We evaluated 1703 patients (mean age: 67 +/- 12 years, 82% male) with conventional ICD indications, who were enrolled and followed between 2001 and 2004 at 128 US centres. Patients were followed for up to a year, and vital status was obtained for 1655 patients (97%, median follow-up: 377 days). There were 183 deaths within 1 year of ICD implantation (1-year mortality rate: 16%). Predictors of mortality included a history of atrial fibrillation (AF, P < 0.0001), diabetes (P = 0.0001), failure to use cholesterol-lowering medications (P < 0.001), use of digitalis and derivatives (P < 0.0001), use of diuretics (P < 0.0001), low body mass index (BMI, P < 0.0001), increasing age (P < 0.0001), low left ventricular ejection fraction (P < 0.0001), low activity hours (P < 0.0001), elevated resting heart rate (P = 0.014), low mean arterial pressure (MAP, P = 0.007), and poor functional status (New York Heart Association class, P < 0.0001). In multivariate modelling, AF (P < or = 0.001), diabetes (P = 0.004), BMI (P = 0.001), MAP (P = 0.040), and functional class (P = 0.006) predicted mortality.
Conclusion:
In this population undergoing ICD implantation, poor functional status, low MAP, diabetes, low BMI, and AF were strongly associated with death within a year.
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