Experience with implantable cardioverter defibrillator therapy in elderly patients

Concern exists about the benefit of implantable defibrillator therapy in elderly patients. We assessed the utility of implantable defibrillator therapy and its effect on mortality in patients 70 years and older and compared results in this group to those in younger patients.

Thirty-two out of 200 consecutive patients (16%) were 70 years or older at the time of implantation of a defibrillator. When comparing elderly to younger patients no significant differences were noted with respect to presenting arrhythmia, left ventricular ejection fraction or presence of an old myocardial infarction. Elderly patients had a higher prevalence of ischaemic heart disease, while in the younger group more patients had idiopathic ventricular tachycardia. Cumulative survival curves (Kaplan-Meier method) for all-cause mortality, sudden cardiac death and non-sudden cardiac death were constructed for elderly and younger patients. No significant differences for cumulative survival from all-cause mortality (75 vs 74%), sudden cardiac death (0 vs 4%) and non-sudden cardiac death (97 vs 93%) were found. The incidence of appropriate shocks during follow-up was comparable (65 vs 72%).

Implantable defibrillator therapy was effective in preventing sudden cardiac death in the elderly. Total mortality was similar to younger patients at a follow-up of 19 +/- 14 and 25 +/- 19 months, respectively. Age itself should be no contraindication to implantable cardioverter defibrillator therapy.