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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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A New Single Chamber Implantable Defibrillator with Atrial Sensing: A Practical Demonstration of Sensing and Ease of Implantation

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Comparison of second appropriate defibrillator therapy occurrence in patients implanted for primary prevention and

Yasuhito Kotake1, Ryobun Yasuoka1, Motohide Tanaka1

  • 1Department of Internal Medicine, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan.

International Journal of Cardiology. Heart & Vasculature
|January 18, 2021
PubMed

Insights

Primary prevention patients receiving an implantable cardioverter defibrillator (ICD) face a similar risk of a second appropriate therapy (app-Tx) as secondary prevention patients. This highlights the need for careful monitoring after the first event in all patients.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Patients receiving an implantable cardioverter defibrillator (ICD) for primary prevention of sudden cardiac death generally have a lower incidence of appropriate therapy (app-Tx) compared to those receiving it for secondary prevention.
  • Detailed analysis of the occurrence of a second app-Tx following an initial event is lacking, particularly when comparing primary and secondary prevention groups.

Purpose of the Study:

  • To compare the incidence of a second appropriate ICD therapy (app-Tx) between patients receiving an ICD for primary versus secondary prevention of sudden cardiac death.
  • To investigate if baseline structural heart disease influences the risk of a second app-Tx in primary versus secondary prevention patients.

Main Methods:

  • Sub-analysis of the prospective, observational Nippon Storm Study involving 985 patients with structural heart disease (left ventricular ejection fraction ≤ 50%).
  • Selection of 251 patients who experienced at least one appropriate ICD therapy.
  • Comparison of the occurrence of a second app-Tx between primary prevention (n=116) and secondary prevention (n=135) patient groups.

Main Results:

  • No significant difference was observed in the cumulative incidence of a second app-Tx between primary and secondary prevention patients at 1 year (59% vs. 59%) and 3 years (79% vs. 75%).
  • Evaluation of second app-Tx incidence based on basal structural disease (ischemic and non-ischemic cardiomyopathy) also revealed no significant difference between primary and secondary prevention groups.

Conclusions:

  • Once a first appropriate ICD therapy occurs, primary prevention patients are at a high risk for subsequent ventricular arrhythmias.
  • The incidence of a second app-Tx is comparable between primary and secondary prevention patients, suggesting similar risk profiles post-initial event.
  • This finding underscores the importance of vigilant monitoring and risk stratification for all patients experiencing an appropriate ICD therapy, regardless of their initial prevention indication.
Abstract

Keywords:
Appropriate ICD therapyImplantable cardioverter defibrillatorPrimary preventionVentricular arrhythmia

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