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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
CRO-INSIGHT: Utilization of Implantable Cardioverter Defibrillators in Non-ischemic and Ischemic Cardiomyopathy in a
Mislav Puljevic1,2, Eugen Ciglenecki2, Vedran Pasara1
1Department of Cardiovascular Diseases, University Hospital Centre Zagreb, 10000 Zagreb, Croatia.
Insights
Implantable cardioverter defibrillators (ICDs) improve survival in heart failure patients when appropriately activated. Age, non-sustained ventricular tachycardia, and decompensation history are key predictors for ICD activation and survival outcomes.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Research
Background:
- Implantable cardioverter defibrillators (ICDs) reduce sudden cardiac death in heart failure, but efficacy in non-ischemic cases is debated.
- Previous studies, like the DANISH trial, question ICD effectiveness in non-ischemic heart failure, especially in older individuals.
- This study evaluates survival in a Croatian cohort receiving ICDs or cardiac resynchronization therapy defibrillators (CRT-D).
Purpose of the Study:
- To assess survival outcomes in patients with ICD or CRT-D devices.
- To identify predictors of survival and device activation in a real-world cohort.
- To inform patient selection for ICD therapy, particularly in non-ischemic heart failure.
Main Methods:
- Retrospective cohort study of 614 patients implanted with ICD or CRT-D between 2009-2018.
- Data collection included demographics, device indication, clinical parameters, and follow-up for device activation and survival.
- Statistical analysis involved descriptive statistics, Kaplan-Meier survival estimates, and Cox regression models.
Main Results:
- The cohort (83.4% male, mean age 58.7) predominantly had reduced ejection fraction (31.4%) and NYHA class II/III.
- Over median 48.4 months follow-up, 36.6% died; 30.3% experienced device activation (88.2% appropriate).
- Cox regression identified age, non-sustained ventricular tachycardia (NSVT), and decompensation history as significant survival predictors.
Conclusions:
- Appropriate ICD/CRT-D activation is associated with improved survival.
- Age, NSVT, and prior decompensation are critical predictors for device activation and survival.
- Individualized patient assessment is crucial for ICD implantation, especially in non-ischemic heart failure.
Background:
Implantable cardioverter defibrillators (ICDs) have significantly reduced the incidence of sudden cardiac death in patients with heart failure, particularly those with ischemic heart disease. However, the impact on overall mortality remains controversial, especially in non-ischemic heart failure patients. The Danish Study to Assess the Efficacy of ICDs in Patients with Non-Ischemic Systolic Heart Failure (DANISH) trial and subsequent studies have questioned the efficacy of ICDs in this population, particularly among older patients. The present study aimed to evaluate survival outcomes and predictors in a Croatian cohort of patients with an ICD or cardiac resynchronization therapy defibrillator (CRT-D) device.
Methods:
This retrospective cohort study analyzed data from 614 patients who received an ICD or CRT-D device at KBC Zagreb between 2009 and 2018. Patient data, including demographic information, device indication, and clinical parameters, were collected at the time of implantation. Follow-up data were systematically recorded to assess device activation and survival outcomes. Statistical analyses included a detailed descriptive analysis, Kaplan-Meier survival estimates, and Cox regression models.
Results:
The cohort consisted predominantly of males (83.4%), with a mean age of 58.7 years. Most had reduced left ventricular ejection fraction (mean 31.4%) and were classified as New York Heart Association (NYHA) class II or III. Over a median follow-up of 48.4 months, 36.6% of patients died. Device activation occurred in 30.3% of patients, with appropriate activation observed in 88.2% of these cases. Cox regression identified age, non-sustained ventricular tachycardia (NSVT), and decompensation history as significant survival predictors.
Conclusions:
This study confirmed that appropriate device activation improved survival in patients with an ICD/CRT-D. Age, NSVT, and history of decompensation were key predictors of device activation and survival outcomes. These findings underscore the need for individualized patient assessment when considering inserting ICDs, particularly in non-ischemic heart failure patients. Further research is needed to refine clinical guidelines and optimize patient selection for ICD therapy.
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