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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
Clinical Impact of Implantable Cardioverter-Defibrillator Therapy and Mortality Prediction Model for Effective
Myung Hwan Bae1, Yongkeun Cho1, Jongmin Hwang2
1Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
Insights
Implantable cardioverter-defibrillator (ICD) therapy is effective for primary prevention in Asian patients, with poor prognostic factors aiding risk stratification. This study highlights the need to identify patients who will benefit most from ICDs.
Area of Science:
- Cardiology
- Electrophysiology
- Preventive Medicine
Background:
- Limited data exists on implantable cardioverter-defibrillator (ICD) efficacy for primary prevention in Asian populations.
- Stratifying patients for primary prevention ICD therapy is crucial for optimizing outcomes.
Purpose of the Study:
- To evaluate the efficacy of ICD therapy for primary prevention in Asian patients.
- To identify factors for risk stratification in primary prevention ICD recipients.
Main Methods:
- A multicenter study in Korea enrolled 305 patients with reduced left ventricular systolic function or ventricular arrhythmias.
- Patients were divided into primary (n=167) and secondary (n=138) prevention groups for new ICD implantation.
- Follow-up averaged 2.6 years, monitoring for appropriate ICD therapy and all-cause mortality.
Main Results:
- Appropriate ICD therapy occurred in 25.6% of patients; shock rates were similar between primary and secondary prevention groups (12% vs. 18.8%).
- Appropriate ICD therapy, including anti-tachycardia pacing, was significantly higher in the secondary prevention group (34.8% vs. 18%).
- Poor prognostic factors (high NT-proBNP, NYHA class, low eGFR, low BMI) predicted death before ICD shock in the primary prevention group, with a risk score effectively stratifying mortality.
Conclusions:
- Appropriate ICD therapy is frequent in the primary prevention group in this Asian cohort.
- Combining heart failure prognostic factors aids in stratifying patients who may not benefit from primary prevention ICD therapy.
Background:
Studies on the efficacy of implantable cardioverter-defibrillator (ICD) therapy for primary prevention in Asian patients are relatively lacking compared to those for secondary prevention. Also, it is important to stratify which patients will benefit from ICD therapy for primary prevention.
Methods:
Of 483 consecutive patients who received new implantation of ICD in 9 centers in Korea, 305 patients with reduced left ventricular systolic function and/or documented ventricular fibrillation/tachycardia were enrolled and divided into primary (n = 167) and secondary prevention groups (n = 138).
Results:
During mean follow-up duration of 2.6 ± 1.6 years, appropriate ICD therapy occurred in 78 patients (25.6%), and appropriate ICD shock and anti-tachycardia pacing occurred in 15.1% and 15.1% of patients, respectively. Appropriate ICD shock rate was not different between the two groups (primary 12% vs. secondary 18.8%, P = 0.118). However, appropriate ICD therapy rate including shock and anti-tachycardia pacing was significantly higher (primary 18% vs. secondary 34.8%, P = 0.001) in the secondary prevention group. Type of prevention and etiology, appropriate and inappropriate ICD shock did not affect all-cause death. High levels of N-terminal pro-B-type natriuretic peptide, New York Heart Association functional class, low levels of estimated glomerular filtration ratio, and body mass index were associated with death before appropriate ICD shock in the primary prevention group. When patients were categorized in 5 risk score groups according to the sum of values defined by each cut-off level, significant differences in death rate before appropriate ICD shock were observed among risk 0 (0%), 1 (3.6%), 2 (3%), 3 (26.5%), and 4 (40%) (P < 0.001).
Conclusion:
In this multicenter regional registry, the frequency of appropriate ICD therapy is not low in the primary prevention group. In addition, combination of poor prognostic factors of heart failure is useful in risk stratification of patients who are not benefiting from ICD therapy for primary prevention.
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