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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
Early mortality after implantable cardioverter defibrillator: Incidence and associated factors
Rodrigue Garcia1, Serge Boveda2, Pascal Defaye3
1CHU Poitiers, 86021, Poitiers, France.
Insights
Identifying patients at risk for early death after implantable cardioverter defibrillator (ICD) implantation is crucial. Older age, higher NYHA class, and atrial fibrillation predict mortality within one year.
Area of Science:
- Cardiology
- Medical Devices
- Public Health
Background:
- Implantable cardioverter defibrillators (ICDs) are recommended for patients with a reasonable expectation of survival.
- Identifying patients at high risk for early mortality after ICD implantation can be challenging.
- Early mortality prediction is essential for appropriate ICD candidate selection.
Purpose of the Study:
- To identify factors associated with survival of ≤1 year in patients receiving primary prevention ICDs.
- To determine predictors of early death following ICD implantation.
Main Methods:
- A multicenter, observational French study (DAI-PP program) included patients receiving primary prevention ICDs (2002-2012).
- Patient characteristics were compared between those surviving ≤1 year and >1 year post-implantation.
- Multivariate analysis identified significant predictors of early mortality.
Main Results:
- Out of 5,457 patients, 4.2% (230) survived ≤1 year.
- Patients with ≤1-year survival had lower rates of appropriate and inappropriate ICD therapies.
- Older age, higher NYHA class (≥III), and atrial fibrillation were significant predictors of ≤1-year survival.
Conclusions:
- This study identified key clinical factors predicting early mortality after ICD implantation.
- Patients with ≤1-year survival exhibited lower ICD therapy rates.
- A combination of clinical factors can help identify high-risk ICD candidates for improved selection.
Background:
According to guidelines, implantable cardioverter defibrillator (ICD) candidates must have a "reasonable expectation of survival with a good functional status >1 year". Identifying risk for early mortality in ICD candidates could be challenging. We aimed to identify factors associated with a ≤1-year survival among patients implanted with ICDs.
Methods:
The DAI-PP program was a multicenter, observational French study that included all patients who received a primary prevention ICD in the 2002-2012 period. Characteristics of patients who survived ≤1 year following the implantation were compared with those who survived >1 year, and predictors of early death determined.
Results:
Out of the 5539 enrolled patients, survival status at 1 year was known for a total of 5,457, and overall 230 (4.2%) survived ≤1 year. Causes of death were similar in the two groups. Patients with ≤1-year survival had lower rates of appropriate (14 vs. 23%; P = 0.004) and inappropriate ICD therapies (2 vs. 7%; P = 0.009) than patients who lived >1 year after ICD implantation. In multivariate analysis, older age, higher NYHA class (≥III), and atrial fibrillation were significantly associated with ≤1-year survival. Presence of all 3 risk factors was associated with a cumulative 22.63% risk of death within 1 year after implantation.
Conclusions:
This is the largest study determining the factors predicting early mortality after ICD implantation. Patients dying within the first year had low ICD therapy rates. A combination of clinical factors could potentially identify patients at risk for early mortality to help improve selection of ICD candidates.
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