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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation
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Implantable cardioverter-defibrillators in the elderly: rationale and specific age-related considerations

Sérgio Barra1, Rui Providência2, Luís Paiva3

  • 1Cardiology Department, Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge CB23 3RE, UK sergioncbarra@gmail.com.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|December 7, 2014
PubMed

Insights

Implantable cardioverter-defibrillators (ICDs) are safe for elderly patients, but survival benefits are questionable due to higher non-arrhythmic mortality. Selection should prioritize biological age and low comorbidity for potential benefit.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Medical Device Technology

Background:

  • Implantable cardioverter-defibrillators (ICDs) are increasingly used in elderly patients.
  • Data on the clinical and cost-effectiveness of ICDs in this demographic are conflicting.
  • There is a need to identify elderly patients most likely to benefit from ICD therapy.

Purpose of the Study:

  • To review the applicability, safety, and effectiveness of ICDs in elderly patients.
  • To analyze which elderly patients are most likely to achieve survival benefits from ICD implantation.
  • To assess the cost-effectiveness of ICDs in the geriatric population.

Main Methods:

  • Comprehensive literature review of state-of-the-art data.
  • Analysis of peri-procedural risks and effectiveness in older versus younger individuals.
  • Evaluation of factors influencing survival benefit and cost-effectiveness.

Main Results:

  • ICD implantation is relatively safe in the elderly, with slightly higher peri-procedural risks.
  • The effectiveness of ICDs in correcting life-threatening arrhythmias is comparable across age groups.
  • Overall survival benefit in the elderly may be limited by higher non-arrhythmic mortality, but selected patients can benefit.
  • ICD therapy may not be cost-effective for the elderly as a group, but can be for carefully selected individuals with longer life expectancy.

Conclusions:

  • ICD implantation is a safe procedure for elderly patients.
  • Patient selection for ICD therapy should focus on biological age, risk of arrhythmic death, and minimal comorbidities, rather than chronological age alone.
  • Cost-effectiveness is achievable in selected elderly patients with an expected survival of over 5-7 years.

Keywords:
ArrhythmiaClinical effectivenessCost-effectivenessElderlyImplantable cardioverter-defibrillatorRisk stratificationSafetySudden deathSurvival

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