Incidence of appropriate anti-tachycardia therapies after elective generator replacement in patient with heart failure initially implanted with a defibrillator for primary prevention

Results of a meta-analysis

Research output: Contribution to journalArticle

Abstract

Background: Implantable cardioverter-defibrillator (ICD) is an effective therapy to reduce mortality in heart failure. When the ICD generator approaches the end of life, most of the patients undergo an elective generator replacement (GR) even if they no longer meet implantation criteria. Whether arrhythmic risk should be re-assessed at the time of GR is still an open question. The aim of our study was to assess, via a meta-analysis, the occurrence of appropriate ICD therapies after GR in patients stratified based on the presence/absence of ICD indication at the time of GR. Methods: Via a systematic literature search for primary prevention studies (January 2000-Sectember 2018), 2976 studies were analyzed. 6 studies were lastly included. Patients were categorized into two groups: “with ICD indication” in case of LVEF≤35% at the time of GR and/or appropriate therapies during the first ICD life; “without ICD indication” in case of a LVEF>35% and no previous ICD therapies. Incidences of appropriate ICD therapies were computed as number of events per 100 person-year. Result: We included 478 pts. (65%) with and 255 patients (35%) without persistent ICD indication. The incidence of appropriate therapies was 12.3/100-person-year in patients with vs. 3.4 in patients without persistent ICD indication (2.98 fold higher risk of ICD therapies). Conclusion: Patients who no longer meet ICD implantation criteria at the time of GR present a significantly lower risk of appropriate ICD therapies after GR. The results of this study underline the importance of an arrhythmic risk re-stratification at the time of GR.

Original languageEnglish
JournalInternational Journal of Cardiology
DOIs
Publication statusAccepted/In press - Jan 1 2019

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Defibrillators
Implantable Defibrillators
Primary Prevention
Tachycardia
Meta-Analysis
Heart Failure
Incidence
Therapeutics

Keywords

  • Appropriate therapies
  • CRT-D
  • Generator replacement
  • Heart failure
  • ICD
  • Meta-analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{6a6eb0a612104aaea9e838555f1064fe,
title = "Incidence of appropriate anti-tachycardia therapies after elective generator replacement in patient with heart failure initially implanted with a defibrillator for primary prevention: Results of a meta-analysis",
abstract = "Background: Implantable cardioverter-defibrillator (ICD) is an effective therapy to reduce mortality in heart failure. When the ICD generator approaches the end of life, most of the patients undergo an elective generator replacement (GR) even if they no longer meet implantation criteria. Whether arrhythmic risk should be re-assessed at the time of GR is still an open question. The aim of our study was to assess, via a meta-analysis, the occurrence of appropriate ICD therapies after GR in patients stratified based on the presence/absence of ICD indication at the time of GR. Methods: Via a systematic literature search for primary prevention studies (January 2000-Sectember 2018), 2976 studies were analyzed. 6 studies were lastly included. Patients were categorized into two groups: “with ICD indication” in case of LVEF≤35{\%} at the time of GR and/or appropriate therapies during the first ICD life; “without ICD indication” in case of a LVEF>35{\%} and no previous ICD therapies. Incidences of appropriate ICD therapies were computed as number of events per 100 person-year. Result: We included 478 pts. (65{\%}) with and 255 patients (35{\%}) without persistent ICD indication. The incidence of appropriate therapies was 12.3/100-person-year in patients with vs. 3.4 in patients without persistent ICD indication (2.98 fold higher risk of ICD therapies). Conclusion: Patients who no longer meet ICD implantation criteria at the time of GR present a significantly lower risk of appropriate ICD therapies after GR. The results of this study underline the importance of an arrhythmic risk re-stratification at the time of GR.",
keywords = "Appropriate therapies, CRT-D, Generator replacement, Heart failure, ICD, Meta-analysis",
author = "Roberto Rordorf and Stefano Cornara and Catherine Klersy and Simone Savastano and Alessandro Vicentini and Antonio Sanzo and Barbara Petracci and Stefano Ghio and {Oltrona Visconti}, Luigi and {De Ferrari}, {Gaetano M.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.ijcard.2018.12.068",
language = "English",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Incidence of appropriate anti-tachycardia therapies after elective generator replacement in patient with heart failure initially implanted with a defibrillator for primary prevention

T2 - Results of a meta-analysis

AU - Rordorf, Roberto

AU - Cornara, Stefano

AU - Klersy, Catherine

AU - Savastano, Simone

AU - Vicentini, Alessandro

AU - Sanzo, Antonio

AU - Petracci, Barbara

AU - Ghio, Stefano

AU - Oltrona Visconti, Luigi

AU - De Ferrari, Gaetano M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Implantable cardioverter-defibrillator (ICD) is an effective therapy to reduce mortality in heart failure. When the ICD generator approaches the end of life, most of the patients undergo an elective generator replacement (GR) even if they no longer meet implantation criteria. Whether arrhythmic risk should be re-assessed at the time of GR is still an open question. The aim of our study was to assess, via a meta-analysis, the occurrence of appropriate ICD therapies after GR in patients stratified based on the presence/absence of ICD indication at the time of GR. Methods: Via a systematic literature search for primary prevention studies (January 2000-Sectember 2018), 2976 studies were analyzed. 6 studies were lastly included. Patients were categorized into two groups: “with ICD indication” in case of LVEF≤35% at the time of GR and/or appropriate therapies during the first ICD life; “without ICD indication” in case of a LVEF>35% and no previous ICD therapies. Incidences of appropriate ICD therapies were computed as number of events per 100 person-year. Result: We included 478 pts. (65%) with and 255 patients (35%) without persistent ICD indication. The incidence of appropriate therapies was 12.3/100-person-year in patients with vs. 3.4 in patients without persistent ICD indication (2.98 fold higher risk of ICD therapies). Conclusion: Patients who no longer meet ICD implantation criteria at the time of GR present a significantly lower risk of appropriate ICD therapies after GR. The results of this study underline the importance of an arrhythmic risk re-stratification at the time of GR.

AB - Background: Implantable cardioverter-defibrillator (ICD) is an effective therapy to reduce mortality in heart failure. When the ICD generator approaches the end of life, most of the patients undergo an elective generator replacement (GR) even if they no longer meet implantation criteria. Whether arrhythmic risk should be re-assessed at the time of GR is still an open question. The aim of our study was to assess, via a meta-analysis, the occurrence of appropriate ICD therapies after GR in patients stratified based on the presence/absence of ICD indication at the time of GR. Methods: Via a systematic literature search for primary prevention studies (January 2000-Sectember 2018), 2976 studies were analyzed. 6 studies were lastly included. Patients were categorized into two groups: “with ICD indication” in case of LVEF≤35% at the time of GR and/or appropriate therapies during the first ICD life; “without ICD indication” in case of a LVEF>35% and no previous ICD therapies. Incidences of appropriate ICD therapies were computed as number of events per 100 person-year. Result: We included 478 pts. (65%) with and 255 patients (35%) without persistent ICD indication. The incidence of appropriate therapies was 12.3/100-person-year in patients with vs. 3.4 in patients without persistent ICD indication (2.98 fold higher risk of ICD therapies). Conclusion: Patients who no longer meet ICD implantation criteria at the time of GR present a significantly lower risk of appropriate ICD therapies after GR. The results of this study underline the importance of an arrhythmic risk re-stratification at the time of GR.

KW - Appropriate therapies

KW - CRT-D

KW - Generator replacement

KW - Heart failure

KW - ICD

KW - Meta-analysis

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U2 - 10.1016/j.ijcard.2018.12.068

DO - 10.1016/j.ijcard.2018.12.068

M3 - Article

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -