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Published on: February 28, 2012
Incidence and Predictors of Appropriate Implantable Cardioverter Defibrillator Therapy in Japanese Ischemic Heart
Kenji Hanada1, Shingo Sasaki1, Takahiko Kinjo1
1Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine.
Insights
This study found that Japanese ischemic heart disease patients receiving an implantable cardioverter defibrillator (ICD) had similar appropriate therapy rates for primary and secondary prevention. Sustained ventricular tachycardia (VT) was a key predictor of therapy needs.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Implantable cardioverter defibrillators (ICDs) are crucial for preventing sudden cardiac death.
- Data on appropriate ICD therapy incidence and predictors in Japanese ischemic heart disease (IHD) patients are limited.
Purpose of the Study:
- To investigate the incidence and predictors of appropriate ICD therapy in Japanese IHD patients.
- To compare outcomes between primary and secondary prevention groups.
Main Methods:
- Retrospective study of 141 Japanese IHD patients undergoing ICD or CRT-D implantation.
- Follow-up period of 5.5 years.
- Cox proportional hazard analysis to identify predictors of appropriate ICD therapy.
Main Results:
- Similar incidence of appropriate ICD therapy in primary and secondary prevention groups.
- Higher frequency of therapy in the first 2 years for secondary prevention.
- Sustained ventricular tachycardia (VT) before implantation independently predicted appropriate ICD therapy, but ventricular fibrillation (VF) did not.
- 49.2% of patients received a second appropriate ICD therapy within 6 months of the first.
Conclusions:
- Appropriate ICD therapy incidence is comparable between primary and secondary prevention in Japanese IHD patients.
- A high-risk period exists for second appropriate ICD therapy after the first.
- Sustained VT is a significant risk factor for appropriate ICD therapy.
Background:
Although the efficacy of an implantable cardioverter defibrillator (ICD) in preventing sudden cardiac death is well established, the incidence and predictors of appropriate ICD therapy in Japanese ischemic heart disease (IHD) patients remain unclear.
Methods And Results:
We retrospectively studied Japanese 141 IHD patients undergoing transvenous ICD or cardiac resynchronization therapy with a defibrillator (CRT-D) implantation for primary or secondary prevention at Hirosaki University Hospital. Over a mean (±SD) follow-up period of 5.5±2.8 years, the incidence of appropriate ICD therapy was similar in the primary and secondary prevention groups, although it was relatively more frequent in the first 2 years in the secondary prevention group. Four patients died due to sustained ventricular tachycardia (VT) or ventricular fibrillation (VF), mainly due to post-shock pulseless electrical activity. Once patients had received their first appropriate ICD therapy, 49.2% received second appropriate ICD therapy within 6 months. Cox proportional hazard analysis revealed that sustained VT as an index life-threatening ventricular tachyarrhythmia before ICD/CRT-D implantation was an independent predictor of appropriate ICD therapy, but VF was not.
Conclusions:
The incidence of appropriate ICD therapy was comparable in primary and secondary prevention among Japanese IHD patients. We need to recognize the high-risk period for second appropriate ICD therapy after the first therapy and sustained VT as index life-threatening ventricular tachyarrhythmia as a risk factor for appropriate ICD therapy.
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