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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Published on: February 26, 2013

Safety and effectiveness of primary prevention cardioverter defibrillators in octogenarians

William Strimel1, Sheri Koplik, H Robert Chen

  • 1Section of Cardiac Electrophysiology and Pacing, Division of Cardiology, Texas A&M University Health Science Center, College of Medicine, Temple, Texas, USA.

Pacing and Clinical Electrophysiology : PACE
|March 29, 2011
PubMed

Insights

Implantable cardioverter-defibrillators (ICDs) are safe and effective for primary prevention of sudden cardiac death in patients 80 and older. Cardiac resynchronization therapy-defibrillator (CRT-D) implantation further reduced mortality risk in this elderly population.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Medical Devices

Background:

  • Implantable cardioverter-defibrillators (ICDs) are established for reducing sudden cardiac death (SCD) in patients with reduced left ventricular ejection fraction.
  • The efficacy and safety of ICDs in the very elderly (≥80 years) remain less understood.

Purpose of the Study:

  • To evaluate the safety and effectiveness of primary prevention ICD implantation in patients aged 80 years and older.
  • To compare outcomes between standard ICD and cardiac resynchronization therapy-defibrillator (CRT-D) in this population.

Main Methods:

  • Retrospective analysis of patients aged 80+ who received an initial ICD for primary SCD prevention between 1995 and 2010.
  • Data collected included periprocedural complications, device type, therapies delivered, and survival outcomes.

Main Results:

  • Eighty-four eligible patients (mean age 82.68 years) were analyzed with a mean follow-up of 34 months.
  • The 5-year survival estimate was 60%, with a low rate of serious periprocedural complications (4.8%).
  • Cardiac resynchronization therapy-defibrillator (CRT-D) implantation was associated with significantly prolonged survival compared to ICD alone (HR 0.212, P=0.042).

Conclusions:

  • Primary prevention ICD implantation in patients 80 years or older is associated with a low risk of complications and a favorable 5-year survival rate.
  • Inappropriate device therapies were infrequent.
  • CRT-D implantation demonstrates a survival benefit over standard ICD in selected elderly patients, suggesting its value in this demographic.
Abstract

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