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Published on: February 28, 2012
Benefits of Implantable Cardioverter-Defibrillator for Secondary Prevention in Patients With Organic Heart Disease
Rie Akagawa1, Sou Otsuki1, Minori Sakurazawa1
1Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Insights
Elderly patients with a history of ventricular fibrillation (VF) may receive limited benefit from implantable cardioverter-defibrillators (ICDs). This study identified age and VF history as predictors of death without appropriate ICD therapy in patients with organic heart disease.
Area of Science:
- Cardiology
- Electrophysiology
- Preventive Medicine
Background:
- Implantable cardioverter-defibrillators (ICDs) are crucial for preventing sudden cardiac death in patients with ventricular tachycardia/fibrillation (VT/VF).
- A significant portion of patients with organic heart disease (OHD) die without receiving appropriate ICD therapy.
- Identifying predictors of limited benefit from ICDs is essential for optimizing patient selection for secondary prevention.
Purpose of the Study:
- To identify predictors of death without appropriate ICD therapy in patients with OHD who received an ICD or cardiac resynchronization therapy with a defibrillator (CRT-D).
- To evaluate the benefit of ICD/CRT-D therapy for secondary prevention in patients with OHD.
Main Methods:
- Retrospective analysis of patients who received ICD/CRT-D for secondary prevention between 2000 and 2022.
- Exclusion of patients without OHD or those alive without appropriate therapy.
- Classification of patients into "no-benefit" (died or severe disability without appropriate therapy, or died within 1 year of first appropriate therapy) and "benefit" (survived >1 year after appropriate therapy) groups.
- Multivariate analysis to identify independent predictors of "no benefit."
Main Results:
- Of 170 patients analyzed, 25% (43/170) were in the "no-benefit" group.
- Independent predictors of "no benefit" were age >70 years and a history of ventricular fibrillation (VF).
- In patients aged ≥70 years with a history of VF, 71% were classified into the "no-benefit" group.
Conclusions:
- While 75% of patients with OHD benefit from ICD therapy for secondary prevention, elderly patients with a history of VF may experience limited advantages.
- Age and VF history are critical factors in determining ICD benefit for secondary prevention in OHD patients.
- Further research may refine patient selection criteria to maximize ICD benefits and avoid unnecessary procedures in specific subgroups.
Background:
Implantable cardioverter-defibrillators (ICD) are first-line treatment to prevent sudden cardiac death due to recurrent ventricular tachycardia and fibrillation (VT/VF). However, some patients with organic heart disease (OHD) die without ever receiving appropriate ICD therapy. This study aimed to identify predictors of death without appropriate ICD therapy in patients with OHD who received ICD or cardiac resynchronization therapy with a defibrillator (CRT-D) for secondary prevention.
Methods:
We analyzed consecutive patients who received ICD/CRT-D for secondary prevention between 2000 and 2022. Patients without OHD or those alive without appropriate ICD therapy were excluded. The "no-benefit group" included patients who died or developed severe disability without appropriate ICD therapy or those who died within 1 year after their first appropriate therapy. The "benefit group" included patients who survived > 1 year after appropriate therapy. Clinical characteristics were compared between the groups.
Results:
Of the 170 patients analyzed (median follow-up: 9.1 years), 43 (25%) were classified into the no-benefit group (30 died without appropriate therapy, 10 died within 1 year of first appropriate therapy, and 3 developed severe disability without appropriate therapy). Multivariate analyses identified age > 70 years and history of VF as independent predictors of "no benefit." Among patients with VF aged ≥ 70 years, 71% were classified into the no-benefit group.
Conclusions:
Although 75% of patients benefited from ICD therapy for secondary prevention, elderly patients with VF may gain limited benefits from ICD implantation.
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